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EXAMINATION OF THE U.S.

DEPARTMENT OF
VETERANS AFFAIRS BENEFITS DELIVERY AT
DISCHARGE AND QUICK START PROGRAMS

HEARING
BEFORE THE

SUBCOMMITTEE ON DISABILITY ASSISTANCE


AND MEMORIAL AFFAIRS
OF THE

COMMITTEE ON VETERANS AFFAIRS


U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED ELEVENTH CONGRESS
SECOND SESSION

FEBRUARY 24, 2010

Serial No. 11163


Printed for the use of the Committee on Veterans Affairs

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WASHINGTON

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55231

2010

For sale by the Superintendent of Documents, U.S. Government Printing Office


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COMMITTEE ON VETERANS AFFAIRS


BOB FILNER, California, Chairman
CORRINE BROWN, Florida
VIC SNYDER, Arkansas
MICHAEL H. MICHAUD, Maine
STEPHANIE HERSETH SANDLIN, South
Dakota
HARRY E. MITCHELL, Arizona
JOHN J. HALL, New York
DEBORAH L. HALVORSON, Illinois
THOMAS S.P. PERRIELLO, Virginia
HARRY TEAGUE, New Mexico
CIRO D. RODRIGUEZ, Texas
JOE DONNELLY, Indiana
JERRY MCNERNEY, California
ZACHARY T. SPACE, Ohio
TIMOTHY J. WALZ, Minnesota
JOHN H. ADLER, New Jersey
ANN KIRKPATRICK, Arizona
GLENN C. NYE, Virginia

STEVE BUYER, Indiana, Ranking


CLIFF STEARNS, Florida
JERRY MORAN, Kansas
HENRY E. BROWN, JR., South Carolina
JEFF MILLER, Florida
JOHN BOOZMAN, Arkansas
BRIAN P. BILBRAY, California
DOUG LAMBORN, Colorado
GUS M. BILIRAKIS, Florida
VERN BUCHANAN, Florida
DAVID P. ROE, Tennessee

MALCOM A. SHORTER, Staff Director

SUBCOMMITTEE ON DISABILITY ASSISTANCE AND MEMORIAL AFFAIRS


JOHN J. HALL, New York, Chairman
DEBORAH L. HALVORSON, Illinois
JOE DONNELLY, Indiana
CIRO D. RODRIGUEZ, Texas
ANN KIRKPATRICK, Arizona

DOUG LAMBORN, Colorado, Ranking


JEFF MILLER, Florida
BRIAN P. BILBRAY, California

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Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House, public hearing records
of the Committee on Veterans Affairs are also published in electronic form. The printed
hearing record remains the official version. Because electronic submissions are used to
prepare both printed and electronic versions of the hearing record, the process of converting
between various electronic formats may introduce unintentional errors or omissions. Such occurrences are inherent in the current publication process and should diminish as the process
is further refined.

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CONTENTS
February 24, 2010
Page

Examination of the U.S. Department of Veterans Affairs Benefits Delivery


at Discharge and Quick Start Programs ............................................................

OPENING STATEMENTS
Chairman John J. Hall ............................................................................................
Prepared statement of Chairman Hall ...........................................................
Hon. Doug Lamborn, Ranking Republican Member .............................................
Prepared statement of Congressman Lamborn ..............................................

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27
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28

WITNESSES
U.S. Government Accountability Office, Daniel Bertoni, Director, Education,
Workforce, and Income Security Issues .............................................................
Prepared statement of Mr. Bertoni .................................................................
U.S. Department of Defense, Hon. Noel C. Koch, Deputy Under Secretary
of Defense (Wounded Warrior Care and Transition Policy) .............................
Prepared statement of Mr. Koch .....................................................................
U.S. Department of Veterans Affairs, Diana Rubens, Associate Deputy Under
Secretary for Field Operations, Veterans Benefits Administration .................
Prepared statement of Ms. Rubens .................................................................
American Veterans (AMVETS), Raymond C. Kelley, National Legislative Director .....................................................................................................................
Prepared statement of Mr. Kelley ...................................................................
Disabled American Veterans, John L. Wilson, Assistant National Legislative
Director .................................................................................................................
Prepared statement of Mr. Wilson ..................................................................
Iraq and Afghanistan Veterans of America, Thomas Tarantino, Legislative
Associate ...............................................................................................................
Prepared statement of Mr. Tarantino .............................................................
Veterans of Foreign Wars of the United States, Gerald T. Manar, Deputy
Director, National Veterans Service ...................................................................
Prepared statement of Mr. Manar ..................................................................

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36
23
47

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20
43
15
38
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40

SUBMISSION FOR THE RECORD


American Federation of Government Employees, AFLCIO, and AFGE National Veterans Affairs Counsel, statement .......................................................

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MATERIAL SUBMITTED FOR THE RECORD


Post-Hearing Questions and Responses for the Record:
Hon. John J. Hall, Chairman, Subcommittee on Disability Assistance
and Memorial Affairs, Committee on Veterans Affairs, to Daniel
Bertoni, Director, Education, Workforce, and Income Security Issues,
U.S. Government Accountability Office, letter dated March 25, 2010,
and response letter and attachment, dated April 16, 2010 .......................
Hon. John J. Hall, Chairman, Subcommittee on Disability Assistance
and Memorial Affairs, Committee on Veterans Affairs, to Hon. Noel
Koch, Deputy Under Secretary of Defense, Office of Wounded Warrior
Care and Transition Policy, U.S. Department of Defense, letter dated
March 25, 2010, and DoD responses ...........................................................

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Post-Hearing Questions and Responses for the RecordContinued


Hon. John J. Hall, Chairman, Subcommittee on Disability Assistance
and Memorial Affairs, Committee on Veterans Affairs, to Thomas
Tarantino, Legislative Associate, Iraq and Afghanistan Veterans of
America, letter dated March 25, 2010, and IAVA responses ....................
Hon. John J. Hall, Chairman, Subcommittee on Disability Assistance
and Memorial Affairs, Committee on Veterans Affairs, to Gerald T.
Manar, Deputy Director, National Veterans Service, Veterans of Foreign Wars of the United States, letter dated March 25, 2010, and
VFW responses ..............................................................................................
Hon. John J. Hall, Chairman, Subcommittee on Disability Assistance
and Memorial Affairs, Committee on Veterans Affairs, to Raymond
C. Kelley, National Legislative Director, AMVETS, letter dated March
25, 2010, and AMVETS responses ...............................................................
Hon. John J. Hall, Chairman, Subcommittee on Disability Assistance
and Memorial Affairs, Committee on Veterans Affairs, to John L. Wilson, Assistant National Legislative Director, Disabled American Veterans, letter dated March 25, 2010, and DAV responses ..........................
Hon. John J. Hall, Chairman, Subcommittee on Disability Assistance
and Memorial Affairs, Committee on Veterans Affairs, to Diana
Rubens, Associate Deputy Under Secretary for Field Operations, Veterans Benefits Administration, U.S. Department of Veterans Affairs,
letter dated March 25, 2010, and VA responses ........................................

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EXAMINATION OF THE U.S. DEPARTMENT OF


VETERANS AFFAIRS BENEFITS DELIVERY AT
DISCHARGE AND QUICK START PROGRAMS
THURSDAY, FEBRUARY 24, 2010

U.S. HOUSE OF REPRESENTATIVES,


COMMITTEE ON VETERANS AFFAIRS,
SUBCOMMITTEE ON DISABILITY ASSISTANCE AND
MEMORIAL AFFAIRS,
Washington, DC.
The Subcommittee met, pursuant to notice, at 2:03 p.m., in Room
334, Cannon House Office Building, Hon. John J. Hall [Chairman
of the Subcommittee] presiding.
Present: Representatives Hall, Rodriguez, and Lamborn.
Mr. HALL. Welcome to the Subcommittee on Disability Assistance
and Memorial Affairs Subcommittee hearing on Examination of the
U.S. Department of Veterans Affairs (VA) Benefits Delivery at Discharge (BDD) and Quick Start Programs.
Could I ask everyone, please, to rise for the Pledge of Allegiance?
[Pledge of Allegiance.]
Mr. HALL. Thank you, all. Ladies and gentlemen, we are here
today to examine the Benefits Delivery at Discharge or BDD and
Quick Start programs, two components of the pre-discharge program, which were established by the U.S. Departments of Defense
(DoD) and Veterans Affairs to streamline servicemembers transition from active duty to veteran status.
And because of the scheduling problems that we have here in the
House with multiple Committee meetings, I am going to recognize
Ranking Member Lamborn for his opening statement, first.
Mr. Lamborn.

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OPENING STATEMENT OF HON. DOUG LAMBORN

Mr. LAMBORN. Well, thank you, Mr. Chairman. I appreciate your


flexibility in doing this. Normally, I am very happy to go second
here. But I do have to be at another Subcommittee where I am also
the Ranking Member, so it is one of those times when I wish I
could be in two places at once.
I also welcome everyone today to this hearing on the Benefits Delivery at Discharge and Quick Start Programs. These programs are
focused on the concept of providing a seamless transition from military service to civilian life.
I, along with Chairman Hall, my fellow Subcommittee Members,
and many of you here are long-time advocates for creating a seamless transition. Therefore, I am sure we can all recognize the inher(1)

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ent value of beginning the VA claims process while service medical
records are readily available and proof of service-connection is easily established.
Allowing veterans to file VA compensation claims prior to separation from active duty is simply a logical approach. BDD is more efficient than the traditional VA claims process and it eliminates
many problems that are created by the time gap that often exists
between discharge and application for benefits.
Among the requirements to establish eligibility for VA compensation, veterans must be able to show that a condition was incurred
during service and that there is a continuity of treatment between
that incurrence and the current condition for which they are filing.
Obviously with BDD there is no time gap, so it alleviates the
need to show continuity of treatment. This saves both the veteran
and the VA a lot of time and effort obtaining private treatment
records. One can imagine that such efforts can become quite extensive for claims filed several years subsequent to service.
In 2008, full Committee Ranking Member Steve Buyer requested
a U.S. Government Accountability Office (GAO) assessment of the
BDD program. GAOs findings confirmed that allowing claims to be
filed prior to discharge is more efficient than the traditional VA
claims process.
While I am optimistic about the overall assessment of the program, I encourage VA to make every effort to improve the program
and increase access to BDD sites. I believe that processing as many
claims as possible in this manner will have a positive impact
throughout the entire system.
Thank you and I yield back. And once again, thank you,
Mr. Chairman.
[The prepared statement of Congressman Lamborn appears on
p. 28.]

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OPENING STATEMENT OF CHAIRMAN HALL

Mr. HALL. Thank you, Mr. Lamborn.


By way of background, any member of the Armed Forces who has
seen active duty, including those in the Guard and Reserve, are eligible to apply for VA disability benefits prior to leaving military
service through the BDD or Quick Start pre-discharge programs.
During the application process, servicemembers can get help in
completing forms and preparing other required documentation from
VA personnel located at their bases.
Additionally, this pre-discharge program combines, both, the
health exam required by DoD upon exiting the military and the VA
disabilities assessment exam into one single exam. Once a BDD or
Quick Start claim is approved, veterans may begin receiving benefits within 2 or 3 months, instead of the 6 to 7 months it would
typically take if they had applied after discharge under the traditional disability claims process.
Participation in the BDD program is open to servicemembers
who are within 60 to 180 days of being released from active duty
and who are able to complete their scheduled VA medical examinations prior to leaving their points of separation. The Quick Start
program is available to servicemembers within 1 to 59 days of separation from service or servicemembers who do not meet the BDD

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criteria requiring availability for all examinations prior to discharge.
The BDD program started as a pilot program in 1995 at three
Army bases and three VA regional offices (ROs). In 1998, VA and
DoD fully rolled out the BDD program.
Last Congress, my friend Congressman Peter Welch of Vermont
introduced H.R. 2259, legislation to expand the BDD program to
members of the National Guard and Reserves, which was incorporated in the National Defense Authorization Act for 2008, Public
Law 110181. This statute ensures that Guardsmen as well as Reservists can participate in the VA/DoD pre-discharge program.
In the last 15 years, over 170,000 servicemembers have availed
themselves of the BDD and Quick Start process. The programs
have expanded from 3 military bases to more than 153 locations in
the United States, Germany, and South Korea.
According to VA, the majority of pre-discharge claims, 46,856
claims to be exact, were processed in 2009 in a paperless environment, with an average processing time of 95.5 days. It is VAs stated goal to process all compensation and pension claims in a
paperless environment eventually, and the Subcommittee is committed to helping VA achieve this.
I, along with Congressman Rodriquez, and other Members of this
Committee and Congress, requested that GAO prepare a report to
assess the effectiveness of these programs, Quick Start and BDD,
and I look forward to hearing from the GAO about its report, about
its recommendations, how they have been implemented, and what,
if any, impact they have had upon the pre-discharge program.
We also look forward to feedback from veteran service organizations as well as the VA and DoD on what, if any, resources are
needed that we in Congress can provide to fully realize the full potential of these two programs.
The examination of VA and DoDs pre-discharge program follows
up our last hearing concerning the implementation of the Veterans
Benefits Improvement Act of 2008, which was codified in Public
Law 110389. That law paved the way for a number of initiatives
also targeting the VA claims backlog, which is an issue that concerns us all. It is my hope that the BDD and Quick Start programs
that we are considering today, coupled with the electronic claims
system and other business process transformation efforts in Public
Law 110389, which are currently underway at VA, will together
significantly transform the VA claims processing system so that
someday, someday soon we may play Taps for the VA compensation
and pension (C&P) backlog.
I would like to remind our panelists that the complete written
statements you have submitted are being made a part of the hearing record. Please limit your remarks to 5 minutes so that we can
have sufficient time for questions and avoid the dreaded buzzer for
the votes that will be called at some unknown time.
Our first panel consists of David Bertoni, Director of Education,
Workforce, and Income Security Issues with the Government Accountability Office.
Mr. Bertoni, welcome. You are now recognized for 5 minutes.
[The prepared statement of Chairman Hall appears on p. 27.]

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STATEMENT OF DANIEL BERTONI, DIRECTOR, EDUCATION


WORKFORCE, AND INCOME SECURITY ISSUES, U.S. GOVERNMENT ACCOUNTABILITY OFFICE

Mr. BERTONI. Thank you very much. Good afternoon, Mr. Chairman. I am pleased to be here to discuss the Benefits, Delivery at
Discharge and Quick Start programs which represent a collaborative effort by the Departments of Veterans Affairs and Defense
to expedite the disability claims process for servicemembers. These
programs streamline access to VA disability benefits by allowing
many servicemembers to file and initiate claims development prior
to discharge, thus shortening the time it takes to receive benefits.
Last year over 51,000 claims were filed through both programs.
My statement today draws on our prior work and focuses on two
areas, an assessment of VAs overall management of the BDD program and steps VA and DoD have taken to expand access to both
BDD and Quick Start.
In summary, although VA awards benefits more quickly under
BDD than through the traditional claims process, gaps in program
management and accountability remain. We found that VAs BDD
timeliness measure excludes time spent and claims development
prior to a servicemembers discharge. Thus, VA has limited information on a frequently problematic phase of the process.
Conversely, claims development activities are included in VAs
timeliness measure for traditional claims. Personnel, 12 of the 14
intake sites we reviewed, noted significant claims development
challenges, including difficulty in scheduling and completing exams
and gathering additional medical evidence. We continue to believe
that tracking the time and resources spent on claims development
could help VA mitigate any barriers to program efficiency and servicemember participation.
We also found that VA implemented two key initiatives, consolidation of BDD claims processing activities in two locations and
paperless claims processing, without fully evaluating their effectiveness over prior practices.
While we support VAs efforts to achieve greater efficiencies, we
continue to believe ongoing evaluation is necessary to optimize results for these initiatives. And finally, we identified gaps of VAs
monitoring activities for this program. At the time of our review,
VA reviewed BDD operations in only 16 of 40 Regional Offices and
reviewers rarely examined these cases to ensure they were properly
developed and they lacked protocols to do so. Per our recommendation, VA has since taken steps to increase the scope and quality of
site visits.
In regard to improving servicemember access to expedited services, VA and DoD have taken a number of actions, most notably establishing the Quick Start Program for servicemembers, such as
National Guard and Reservists who are generally unable to complete the BDD application and medical exams prior to discharge.
We have recommended and VA has begun to collect additional
data to assess whether Quick Start is meeting servicemember
needs. However, as with BDD, VA has no plans to track the time
spent developing these claims.
VA and DoD have also coordinated to increase program awareness of BDD and Quick Start through VA benefit briefings and

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DoD has established an 85 percent participation goal for those
briefings. However, our work shows that DoD needs better metrics
for capturing servicemember participation, as well as a service delivery plan for meeting its targeted goal.
Despite these efforts, during our site visits, we identified numerous implementation challenges associated with local DoD and VA
agreements intended to prevent redundancies and servicemember
inconvenience in obtaining required medical exams. These challenges were often due to turnover on base command, communication breakdowns and resource constraints, sometimes resulting in
multiple unnecessary medical exams and delayed claims development.
However, in response to our findings and recommendation, VA
and DoD have begun to explore local office best practices to address
challenges to the cooperative exam process.
And in closing, I want to strongly emphasize that at a time when
so many servicemembers are being discharged with injuries and
the current conflicts in Iraq and Afghanistan, opportunities exist to
improve, both, the BDD and Quick Start programs as long as both
VA and DoD maintain a sharp focus on accountability and follow
through on recommended actions.
Mr. Chairman, this concludes my remarks. I am happy to answer
any questions you may have. I am within my time.
[The prepared statement of Mr. Bertoni appears on p. 28.]
Mr. HALL. Good job setting an example for all witnesses to come.
Mr. BERTONI. Ive set a high bar.
Mr. HALL. And maybe for the Chairman himself.
Thank you, Mr. Bertoni. You point out that VA has established
only one performance measure for BDD and Quick Start programs,
which is tracking participation in the programs. VA does not track
for these claims, as it does for general compensation claims, how
much time a veteran has to wait for a final decision, the average
days that it takes to complete all work to reach a final decision or
the percentage of claims with no processing errors.
How do you think additional performance measurements, such as
those mentioned, could assist VA in fully implementing these programs?
Mr. BERTONI. I think the rationale is that they had the STARreview process, which is a systematic technical accuracy review
where they sample a number of cases. Our concern is that this review is not capturing enough of these type of specialized cases to
give them a good enough reading on what is going on.
So in general, you need good management information data to
improve your program. You need to know how accurate your cases
are, how consistent you are rating cases, how much time they are
being taken to be processed, how long they sit in a particular
phase.
Right now, there are three entry points for getting VA benefits,
the traditional method, the DESthe DoD VA Disability Evaluation System pilot, which down the road might go worldwide, and
there is BDD and Quick Start. For the other two programs, I can
look at the metrics and I can track from time of entry, from time
of application to the time those benefits are delivered and get a

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good sense of what is going on at all phases. That is not the case
with BDD and Quick Start.
Mr. HALL. Your testimony also notes that VA tracks days it
takes to process traditional claims starting with the date that a
veteran first files a claim. Whereas, it tracks days to process BDD
claims starting with the date of discharge of that servicemember.
This approach does not count the time that VA spends developing
the claim while the servicemember is still in active duty or still
under the DoDs purview.
The VA claims it does not measure the full claim processing time
because it lacks legal authority to provide compensation until a
servicemember is discharged and becomes a veteran. Do you have
any suggestions that might allow VA to track the time to process
the entire disability claim, including that time before discharge and
how might this improve the BDD and Quick Start programs?
Mr. BERTONI. Absolutely. I agree they dont have the legal authority to pay the claim but they have the legal authority to develop the case, and if a person applies for benefits while a servicemember, the clock ticks, the VA representatives develop that case,
it gets to a point where it is rating ready and you stop the clock.
So if that is 1, 2 or 3 months, that is the development phase.
Six months down the road, once that person discharges, the clock
starts again. That is the rating phase, whatever that takes, the 76
days. We put those two pieces together. That is development. That
is the entire time for the case to be developed. So it is not a matter
of not having legal authority to pay. They can develop a case before
they are able to pay. It is a matter of doing it.
And again, it is happening with the DES pilot right now between
DoD and VA. They are tracking from date of referral to date of payment and it is possible and we believe it is reasonable for them to
be doing, to make this process more transparent, and it is certainly
to give them the metrics and the data that they can make adjustments down the road.
One thing they have not been able to do is to reach their 60-day
optimal goal at the back end. Perhaps that is due to problems at
the front end with development, but they are not tracking it, they
are not looking at it. If they were, they might be able to make the
adjustments to reach that 60-day goal at the front end.
Mr. HALL. Right. Well, thank you, sir. We have a few examples
that have come before the Committee and the Subcommittee where
VA and DoD have maybe not been as cooperative or may not have
allowed the overlap of work to happen that would enable a seamless transition in several different areas, and since we have representatives from both DoD and VA here, maybe we will get a
chance to talk about that.
But you note in your testimony that most VA and DoD Memorandums of Understanding (MOUs) require a VA physician to administer the joint physical exam required by BDD and Quick Start.
You also mentioned that only 7 percent of those MOUs surveyed
permit disability exams to be administered by either a VA or DoD
physician. Do you suggest that MOUs need to be expanded to permit DoD physicians or contracted physicians to conduct these
exams as well as VA docs? How does the effectiveness of this program suffer as a result of this limitation?

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Mr. BERTONI. I think, again, I will just hearken back to the pilot,
the DES pilot, though that is right now basically, it is primarily
the exams are coming from VA staff. Even in this program, I think
90 percent of the exams are being conducted by either VA staff or
contracted with VA. I think the thinking is they have the broader
expertise to assist in making the fit/unfit decision for the military,
but also to assess and compile all the other potential injuries that
that person might claim down the road for VA benefits.
At the same time, there is leeway in those agreements for DoD
physicians, DoD contractors or some type of hybrid approach between VA and DoD to do, sort of, share those duties.
I think that what it comes down to in a lot of respects is resources. And right now VA has stepped up and I am not sure if
they have asked or what the dialogue is between VA and DoD as
to expanding the role on DoDs end.
Mr. HALL. Well, the dialogue between Secretary Shinseki and
Secretary Gates has certainly been, I think, at a deeper level and
a more cooperative level than what I have noticed in previous cases
of Secretaries of both Departments. Hopefully that cooperative relationship will translate down through both Departments.
You also noted in your testimony that VA has implemented two
initiatives to improve BDD and Quick Start, but that they did not
fully evaluate either. These include VAs consolidating claims, processing activities into two regional offices and creating a paperless
claims processing system. Do you know why VA has not evaluated
these measures and what the implications might be of not doing
that?
Mr. BERTONI. I think the position was that theyI think in one
of the meetings, as far as the electronic processing goes, it was a
proof of concept. It appeared to work. We decided to rule it out.
And now that is ruled out, it didnt make any sense to go back,
cease and desist and evaluate it. We gave them that. At the end
of the day we said that is fine, but we still think that you need to
go back in and develop an evaluation plan for both of these efforts:
What level of performance are you shooting for; what metrics are
you going to measure against in terms of how you are trending;
and, ultimately, how are you evaluating this?
This is basic principles of pilot planning, basic principles of business reengineering processes. We didnt see it. We would hope that
they agree to look at this and monitor it. I dont know what they
are doing right now, but I believe they have gone back and are
looking at some of the aspects of both of those programs. Our recommendations are open. Down the road we will look further into
it and see if we can close them out.
Mr. HALL. Thank you.
Mr. Rodriguez, would you like to ask a question?
Mr. RODRIGUEZ. Yes. Thank you. Let me first apologize for being
late.
Let me ask youI know you have addressed this issue many
times in the past from the GAO perspective and made recommendations and we have had a lot of difficulty in the transition
between DoD and VA. We have pumped in a lot of money trying
to get the DoD and the VA to come together and I think somebody
explained that DoD has another great system; however, and the VA

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has a great system, they just dont talk to each other. I was wondering if you had any thoughts about what we need to do next after
my 12 years on the Committee, this dialogue occurred even before
I arrived here. What do we need to do to or what kind of studies
do we need to do to get us to the next level?
At one point we had talked about getting a private entity to come
in from the outside and try to do the same first and now, as you
have done, the GAO reports indicate a number of areas where a
variety of programs could be tracing data more effectively. What
other GAO studies could be utilized that would give us a better
handle as to how to do this? From your perspective, what other
GAO studies or reports could be helpful for us coming to grips with
this and now moving forward with the VA and trying to get it to
the next level?
Mr. BERTONI. Okay. Let me just say, we have been at the ground
floor at both the DES the pilot, as well as looking at the BDD program for quite some time. So I would say, in terms of two large
bureaucracies coming together and trying to merge or meld two
processes that, I think, both think they do very well, I think there
are just external forcesWalter Reed, the current wars, oversight
on your part, GAObasically involved here are sort of, I dont want
to say forcing, but helping them to work together. And I could say
in, both, the BDD program as well as the DES pilot, there is a lot
of cooperation between the two entities, not always consistent in
terms of how they view every aspect, but I would say, very productive in terms of their cooperation.
In terms of information, we have received and the cooperation we
have received in both those efforts, it has been exceptional, so I
just want you to know that.
I think, as far as further improvement, these two programs, the
BDD and the DES pilot, they are very close, so I am sorryI know
it is BDD, but I want to bring that in also.
They just need to keep working to sort of, to refine the machine,
and I think this report that we issued, we essentially said BDD
and Quick Start is a good program. It has many positive attributes.
It just needs to be refined and tweaked. And if you do some of
these things, it will be a better program in terms of service delivery.
In terms of other reports, we have a body of work. I would much
rather think about that and perhaps submit something to you at
a later time.
Mr. RODRIGUEZ. I would like to see those ideas because a lot of
times you react to what we come out with but you might have a
better feel as to what might be helpful to improve services as we
provide more resources. And at some point we felt, and we should
have for good reason that we werent providing them with the necessary resources.
But as we move forward with resources, we expect them to be
held accountable. Can you provide me or the Chairman, with some
ideas as to how we can go about additional studies that could be
done to allow for more recommendations and how best to do this?
Because as elected officials, our biggest problem is not only the
bureaucracy out there, but I am sure that this is the same case for
the Secretary.

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9
Mr. BERTONI. Sure and, just, I am in the process now of drafting
a report for this Committee, looking at training for VSRs and
RVSRs. That is going to be very important in terms of the fact that
they have hired 4,200 staff over the last several years. These folks
are the folks that are being placed in these rating centers, in these
processing centers. They are the ones that are going to have to
move this work, are crucial to accuracy, consistency and timeliness
of the work.
So I think that is an important piece we are doing it. We will
be out shortly. We also have some work. We just issued and under
way, looking at how they can expedite the backlog problem, so I
will have my staff get in contact with you.
Mr. RODRIGUEZ. With the understanding that, we have only dealt
with about 8 million veterans from 23 million in the country, we
have to continue to push forth on the outreach to our veterans.
Okay. Thank you.
Mr. BERTONI. And the BDD program is a good tool for the outreach and education to sort of bring that service into play earlier
in the servicemembers life.
Mr. HALL. Thank you, Mr. Rodriguez. I would just say that I
think we all are in agreement that these are good programs that
are positive steps for our veterans and we are trying to figure out
how to make them better.
As part of that quest, and noting that VA has created a pre-discharge Web site so that servicemembers can initiate Quick Start or
BDD claim electronically, I wanted to ask you in closing whether
you think this paperless system should be expanded to permit all
claims to be processed or initiated electronically. How much effect
do you think that would have upon the stubborn claims backlog?
Mr. BERTONI. In terms of having accessibility via the Web site,
I think that isall modern business is heading in that direction.
You know, commerce and transactions, that is how it is happening
today. We have servicemembers coming back, these young individuals who have, you know, they are very familiar with that kind of
public service delivery. So any time you can do that, open up another portal for quick service, we would support that.
We have not got in and looked at the actual functioning of that
system, so the jurys out there.
What was the other part of your question?
Mr. HALL. That was it. Thank you.
Thank you, Mr. Bertoni. I appreciate very much your testimony
and look forward to your next progress report, and you are now excused with our gratitude.
Mr. BERTONI. We will follow up on recommendations and keep
you apprised.
Mr. HALL. We will absolutely try to do our best.
Because of scheduling and travel plans, we are going to ask the
Honorable Noel Koch, Deputy Under Secretary of Defense, from the
third panel, to come up and be our next panel all by himself. He
is the Under Secretary for Wounded Warrior Care and Transition
Policy at the U.S. Department of Defense, and we will just take
you, Mr. Under Secretary, out of order so you can make your plane.
As usual, your statement is a part of the written record of this
hearing, so feel free to improvise as you wish for 5 minutes.

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You are now recognized, sir.

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STATEMENT OF HON. NOEL C. KOCH, DEPUTY UNDER SECRETARY OF DEFENSE (WOUNDED WARRIOR CARE AND
TRANSITION POLICY), U.S. DEPARTMENT OF DEFENSE

Mr. KOCH. Thank you, Mr. Chairman, and thank you very much
for your consideration and realigning the witnesses. It is a great
pleasure, as always, to be before this Committee, and as you already have my testimony, this is, of course, this is an area in which
we are, we are a junior partner and, in fact, with the Veterans Administration and happy to be.
So our job and our responsibility is, for the most part, to make
sure that our veteransor not veterans but pre-veterans, people
who are prior to separation, who will be separating, are fully informed on the programs and the benefits that are available to
them.
And so as Mr. Bertoni has indicated, this is very much a work
in progress. The programs, themselves, are unexceptionable, I
think. There is always room for improvement, but I think that the
programs themselves are excellent. The question is, are wehow
is it working on the execution side?
So in the interest of improvement, one of the things that we did,
as you know, I think, Mr. Chairman and Members, our responsibility is to focus on wounded warriors and their care and their
transition either back to active duty or to veteran status. And of
course, many of them do go back on active duty.
And so that, it would appear that our charter is somewhat limited to those people and, of course, the programs that we are talking about are much broader and encompass all the servicemembers
that we have.
So, but, from the perspective, from the place that we stand in
this process, we do touch, I think, morally wounded warriors, but
everybody across the board.
As you are familiar with the Transition Assistance Program
(TAP), this was started during the Gulf War. It is 20 years old, or
more than 20 years old now. And it was very much outdated and
so last November we went away for a week, took this thing apart
completely, along with our colleagues in this endeavor, and put it
back together and updated it so that it accommodates people who
are not very much, very well accommodated previously, our National Guardsmen and our Reservists who are very much engaged
in the fight today.
And so in other areas of communication, again, this seems to be
the entire issue is how do we make our people aware of what is
available to them. And I have now visited many, many hospitals
and warrior transition units and met with hundreds and hundreds,
literally of, just our clients and people we are responsible for, constituents, and it is a constant source of partly amazement and partly disappointment at how little aware they are. And so before we
get to the challenging questions, I think we can stipulate that we
are not doing as well in this communications effort. The numbers
dont show it and the anecdotal revenues doesnt show it, and so
we are working very hard to correct that and to find a way to communicate.

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11
And, Mr. Chairman and Members, you will appreciate this. This
is partly a generational issue. They dont communicate the way
people my age communicate. They dont refer to these thick manuals that we put out, that they are just chock full of information,
which nobody reads.
Even Web sites are becoming somewhat antiquated in the eyes
of some of our younger servicemembers and so we have, and I have
indicated in my testimony, we are moving into social media, such
as Facebook.
It is very successful. We have two Marines on the space station
who are friends of ours on Facebook, and we have other people like
this, and we are working with Twitter, and we are finding some
success here.
Now, how successful are we? These programs are too embryonic
at this point for us to make a judgment to say, okay, we know this
is working, the baseline still remains to be established and I am
about to run out of 5 minutes, and so I will be happy to take your
questions. Thank you.
[The prepared statement of Mr. Koch appears on p. 36.]
Mr. HALL. Thank you, sir. I appreciate your work and your testimony and your brevity and also your written submission, during
which, you point out that servicemembers learn of BDD and Quick
Start programs during the TAP briefings.
However, GAO states that only the Marines have made these
briefings mandatory. We have learned that while DoD policy requires commanders to allow servicemembers to attend TAP sessions upon the Members request, in some cases servicemembers
have not been released from their other duties in order to attend
TAP briefings.
So given this, why are the TAP briefings not made mandatory for
all of the service branches? And further, why not make BDD and
Quick Start available for all servicemembers as a part of the normal discharge process?
Mr. KOCH. Let me answer the first part of your question, Mr.
Chairman, first. Thisyou have touched on a very sore point here,
and it is a sore one with me particularly because we would like to
make just about everything that constitutes a benefit or a prospective benefit for the servicemembers mandatory, for them to be
aware of these things.
And in some cases we have been successful in making that happen. In other cases we have not. There are contravening priorities
here. In some cases, you know, we have limited manpower and
where some of these things can be done in theater, they are also
fighting a war in theater, and so it becomes difficult to persuade
the higher authorities to make certain programs mandatory because the commanders object to that, and so to some extent it becomes almost a local option.
We want it to be mandatory for the servicemember to have, to
be able to be told about it, and then if they want to avail themselves of the additional information to be briefed or counseled,
whatever arrangements are provided for them, then their commanders, it should be mandatory for the commanders to release
them so that they can avail themselves of this benefit. We have

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12
not, in every case, been able to do that, and I think we will just
continually chip away at it.
I am sorry. The second question, I believe, was why are the benefits delivery in Quick Start not available to all of them. Quick
Start, as you know, essentially focused more on the benefit accrues
to the Reservists and that National Guardsmen, more usefully than
to our active components. And the reason for it is, of course, they
dont know. There is a shorter fuse on this, a shorter timeline for
them to get into the system and the reason is because they dont
necessarily know when they are going to be up for rotation.
As far as the BDD is concerned, this is available to everybody.
It is just that not everybody needs to have these benefits. They are
not necessarily all hurt in any way that would give them access,
and in other cases they just dont want to bother with it. And the
third case, as I indicated in my oral testimony, in some cases I am
sure there are people that simply dont know about it because we
have failed to reach them.
Mr. HALL. Well, I appreciate that. I think we all share the goal
that you just stated of having the knowledge of these programs
made available and passed on to every servicemember, be they active duty, Guard or Reserve.
I am still curious as to why the Marines have made the Transition Assistance Program briefings mandatory and the other services have not. I dont know. Maybe we need to get that answer from
somebody else. But it is two schools of thought obviously.
The Quick Start program was created to ensure that our soldiers
serving in active duty who come from Guard and Reserve units can
also take advantage of the benefits of the pre-discharge program.
Are we offering Quick Start at Guard bases? In particular, I am curious whether my own constituents serving, for instance, in the National Guard at Camp Smith and New York and the Hudson Valley, can get a Quick Start exam when they return and demobilize
there?
Mr. KOCH. Mr. Chairman, I think I am going to have to get back
to you on that question because I think it is a split issue. In some
places it is available and other places it is not available.
[The DoD subsequently provided the following information:]

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The Department of Veterans Affairs provides information on the Quick Start program at military installations where demobilization/deactivation of National
Guard and Reserves takes place and there is a VA presence. National Guard and
Reservists can file their Quick Start claim while still on Active Duty; however,
the examination to meet the requirements of Quick Start cannot be accomplished
in the limited time during demobilization/deactivation.
Once the servicemember has completed and submitted the Quick Start application
a VA representative can schedule the member for the Quick Start examination
prior to their release from Active Duty. The actual examination occurs after the
servicemember has returned to home station.

Mr. HALL. Maybe when you get back to us because other Members, I am sure, would like to know for their districts, how that decision is made and what, you know, what percentage of bases and
where they are and, you know, how is it decided that, you know,
which base will have a Quick Start examination available.
And lastly, I want to ask you, the Subcommittee has taken a particular interest in servicemembers suffering from post-traumatic
stress disorder (PTSD), traumatic brain injury (TBI) and military

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13
sexual trauma (MST) to make sure that they receive the benefits
to which they are entitled. The full VA Committee on the House
side has examined how some servicemembers suffering from these
disabilities take their own lives before they get help, or in spite of
getting help, or tragically, we have a record number of veterans
and soldiers who are still in uniform committing suicide or attempting suicide.
With this in mind, could you offer some thoughts about the steps
we are taking during the pre-discharge process to screen for PTSD,
TBI, MST and possible depression or other psychological states
that might lead to suicidal tendencies?
Mr. KOCH. Yes, sir. Let me try to provide a blanket answer to
that if I may. We try to screen for these disabilities before the servicemember moves on tofor example, when they come back from
theater, they are tested to see if they are exhibiting symptoms of
post-traumatic stress or other psychological and mental health
issues that might be debilitating. And we just dont have our arms
around it. I am sorry. Again, I could probably give you a very eloquent long answer that wouldnt make a whole lot of sense and by
the time you distilled it, it would come down to the fact that we
are still just not very good at this.
One of the problems is, I can tell you in my generation coming
back from Vietnam, there are a lot of things that people look for
in terms of symptoms, maybe symptoms of post-traumatic stress,
but they also may be symptoms of the fact that you are just coming
home hot, you dont want to be here in many cases. You know, you
want to be back down range, you want to be with your unit, you
want to be with your friends, you dont want to face the complexity
of the life that you are going back to.
There are a lot of reasons why people come home in ways and
upset and exhibit symptoms that may be construed as post-traumatic stress or otheryou know, TBI is the result of, you know,
that is different. We know what that is. But diagnosing post-traumatic stress is a veryis a problem of a different magnitude and
while the symptoms that you are looking at really are not symptoms, but are being misread, that does not preclude that individual
from suffering from post-traumatic stress 15 or 20 years later and
you are not going to catch it at the front end.
And so where we have very good as itdealing with traumatic
amputations, providing the necessary prosthesis, the counseling
and everything that helps people get back on their feet after they
have lost their legs. We can do that. And even traumatic brain injury is something that we know we can work with this to some degree of feeling like we are making progress. In the area of posttraumatic stress, I dont know that anybody is going to come up
there and say, they are pretty happy, I think we have finally got
our arms around it. If they tell you that, you know, you ought to
have them under oath.
Mr. HALL. I appreciate your candor and honesty, sir. And it is
nice to hear anybody from government or business or anywhere
say, honestly, we dont have our arms around it. This is something
that we all are trying to improve as much as possible, but nobody
at this point, I dont think, expects that we will have a foolproof
way of identifying those people in that kind of trouble.

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14
But before you leave, I just wanted to ask if you have any suggestions or approaches that you are trying or that you suggest that
we might, on the Congressional side, be able to do to help make
that identification?
Mr. KOCH. Well, your funding isat least we are happy with our
fundings. That may be something, if you are people tell you, that
we are satisfied with what we have, we are satisfied with your support, we are grateful for your questions and for yourbecause it
stimulates our thinking.
There is one thing that, I guess, you and all of our colleagues
could help us with and, you may notice when you hear Admiral
Mullen or other senior military leadership talk about the problem
that we just finished discussing, they dont refer to disorder and I
would like to see if we could, first, if we could get this out of the
Diagnostic and Statistical Manual of Mental Disorders manual.
When we talk about post-traumatic stress disorder, we are automatically creating a problem for that individual, because it is a
term that connotes dysfunctionality, it connotes something that is
weird, if you like, in that person, and that is a great disservice to
the individual because when you begin with the notion that it is
a disorder, which I think it should not be called that, then you get
quickly to this issue of stigma, which is just a kinder word for prejudice and it is a short jump from prejudice to discrimination in a
job market and these people shouldnt
Mr. HALL. Thank you, sir. You are echoing the statement of a father of a young veteran who took his own life who testified before
this Subcommittee and suggested that it be called post-traumatic
stress injury or post-traumatic stress syndrome which it use to be.
Anything but disorder because of the fact that it attaches a stigma
to it.
Mr. KOCH. Thank you.
Mr. HALL. To what is actually a human response to an inhuman
experience or living through conditions and events that most
human beings dont have to deal with.
So I appreciate your testimony and your suggestions and I hope
you have a safe travel, sir. Thank you very much for your testimony.
Mr. KOCH. Thank you, Mr. Chairman.
Mr. HALL. Mr. Under Secretary, you are now excused.
Mr. KOCH. Thank you, Counsel.
Mr. HALL. I will go back to our scheduled program and ask Panel
2 to join us now, please, including Thomas Tarantino, Legislative
Associate, Iraq and Afghanistan Veterans of America (IAVA); Gerald T. Manar, Deputy Director of the National Veterans Service,
Veterans of Foreign Wars of the United States (VFW); Raymond C.
Kelley, the National Legislative Director of AMVETS; and Mr.
John L. Wilson, Assistant National Legislative Director for Disabled American Veterans (DAV).
Gentlemen, thank you for your patience. Your written statements
are in the record, and Mr. Tarantino, you are now recognized for
5 minutes.

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STATEMENTS OF THOMAS TARANTINO, LEGISLATIVE ASSOCIATE, IRAQ AND AFGHANISTAN VETERANS OF AMERICA;
GERALD T. MANAR, DEPUTY DIRECTOR, NATIONAL VETERANS SERVICE, VETERANS OF FOREIGN WARS OF THE
UNITED STATES; RAYMOND C. KELLEY, NATIONAL LEGISLATIVE DIRECTOR, AMERICAN VETERANS (AMVETS); AND
JOHN L. WILSON, ASSISTANT NATIONAL LEGISLATIVE DIRECTOR, DISABLED AMERICAN VETERANS

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STATEMENT OF THOMAS TARANTINO

Mr. TARANTINO. Mr. Chairman, thank you very much and on behalf of Iraq and Afghanistan Veterans of Americas 180,000 members and supporters, I would personally like to thank you for the
opportunity to speak before you today and express our views of our
membership on some very important issues.
As an Operation Iraqi Freedom veteran with 10 years of service
in the Army, I have seen firsthand the difficulties many face when
transitioning from being a servicemember to a veteran. For the
wounded warrior torn from service due to their extraordinary sacrifice, or the young veteran who spent most of their formative years
in uniform, the transition can be very difficult. And all too often,
we leave behind the structured, accessible care and benefits of the
military when seeking benefits to the Department of Veterans Affairs, where we are left largely on our own devices.
In response to the need for a more seamless transition from servicemember to veteran, the VA and the Department of Defense have
embarked on several initiatives that allow servicemembers to walk
off post with their benefits in hand. However, the potential of these
programs has yet to be fully realized. And their full impact will not
be felt until the VA begins aggressive outreach to servicemembers
and the DoD makes transition programs uniform and mandatory.
When I left the Army in 2007, I had absolutely no idea of the
scope and availability of the benefits that I was entitled to as a veteran. In fact, it never even occurred to me to seek benefits and
health care from the Department of Veterans Affairs just for the
general wear and tear of a decade of military service. If it werent
for an old Sergeant Major that was attending the Army Civilian
Alumni Program with me, I would have never even applied.
And we cannot rely on word of mouth to spread this information.
The DoD and the VA must integrate their outreach and ensure a
smooth transition of services before a servicemember is ready to
leave the uniform behind. Otherwise, more men and women are
going to fall through the cracks.
Now, as you mentioned, the Marine Corps mandates TAPS programs, I believe, within 90 days of separation, and the Army conducts their Civilian Alumni Program within 30 days of separation.
Both of these programs are useful for what they are, but they really begin far too late to utilize the Benefits Delivery at Discharge
Program. And neither program has comprehensive or mandatory
briefings about the availability of VA services.
The VA must begin to see itself as a military alumni program.
Many of us remember that guy in the cheap suit from our college
alumni society who greets us on freshman year and continues to
pester us throughout college and for years afterward. It may have

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16
been kind of annoying, but the message was communicated clearly
and it was consistent. The VA needs to be communicating at least
that effectively with our veterans. There should be absolutely no
excuse for any veteran not knowing what services are available to
them when they separate. And only when the VA integrates its
outreach and education efforts with the DoD will benefits programs
reach their full potential.
Now, early outreach also requires VA boots on the ground. To effectively utilize Quick Start services the VA must have a presence,
physically, at all military installations in order to provide access
and information to the benefits and services that servicemembers
have earned. Additionally, the VA should offer training to AGR
members of the National Guard and Reserve so that there can be
benefits counselors and educate servicemembers who do not have
the same interaction with the military services as do their active
duty counterparts.
Just as the VA must rethink the way it conducts outreach, the
DoD must understand that it has an inherent responsibility to its
servicemembers to set them up for success whether they retire
from service or they choose to leave before retirement. The military
is a lifestyle. It is not a job. And those who choose this life must
be afforded every opportunity to excel both while in uniform and
when they put the uniform away. The DoD must mandate comprehensive and structured Transitional Assistance Programs that
integrates the VA benefits and services.
Now, in addition to integrating outreach and training, we also
need to address the expedience and accuracy of the benefits process. The Benefits Delivery at Discharge Program generally provides
more accurate and timely benefits to separating servicemembers
than the standard benefits approval process. However, this is largely due to the co-location of the servicemember with their respective
records and the DoD medical facility.
Many of the processing issues that plague the standard system
still do exist, but they are mitigated by the fact that the servicemember is still in uniform, has full access to DoD care and services
while waiting for their rating, thus reducing the time it takes to
develop their claim during these programs.
I think we all know that receiving a disability rating at the VA
can be a long and confusing process for a veteran. And often, veterans must wait for a rating that does not accurately reflect what
they are entitled to. The VA currently uses a disability evaluation
process that was outdated long before many Iraq and Afghanistan
veterans were even born. And this has lead to a situation where
hundreds of thousands of veterans must navigate an antiquated
system that focuses on quantity over quality of processed claims.
And consequently, 17 percent of cases do not accurately compensate veterans for their earned benefits. And as we all know,
this leads to months, if not years, of delayed payments.
And IAVA applauds some of the innovative initiatives that the
VA and the DoD have undertaken to solve this problem, such as
the pilot that integrates the Virtual VA into the Benefits Delivery
at Discharge process and the Six Sigma pilot at the Little Rock Regional Office for the traditional claims process.

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But now it is time to take it to the next level. You know, the Virtual VA is a step in the right direction, but it has to integrate with
the Veterans Health Administration as well as the Board of Appeals process if it is ever to be actually effective. And informational
Web sites, VA.gov and within the DoD are great, but todays veteran expects services through their Web sites in addition to information.
Mr. HALL. Mr. Tarantino if you would summarize with these bullet points and
Mr. TARANTINO. I mean basically
Mr. HALL. I appreciate it. Thank you.
Mr. TARANTINO. Basically, IAVA, along with the other veterans
organizations, are pushing to reform the disability process as a
whole. We want to change the work culture at the VA to emphasize
quality over quantity, we want a modern information technology
(IT) system, and we want a more transparent application process
where that emphasizes customer service and removes unnecessary
steps.
Thank you very much for the opportunity.
[The prepared statement of Mr. Tarantino appears on p. 38.]
Mr. HALL. Thank you, Mr. Tarantino. I am sorry to interrupt
you, but we have votes coming up and I am hoping to get all of
our panelists testimony before that happens.
Mr. Manar, you are now recognized.

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STATEMENT OF GERALD T. MANAR

Mr. MANAR. Mr. Chairman, thank you for this opportunity to


speak before the Subcommittee. On behalf of the 2.1 million men
and women of the Veterans of Foreign Wars of the United States
and our auxiliaries, we appreciate the opportunity to present our
views and concerns regarding the VA Benefits Delivery at Discharge and Quick Start Programs.
In the past 20 years, DoD and VA have made significant strides
to ensure that our newest veterans are better prepared for life after
discharge than any generation of veterans that preceded them. Unfortunately, we believe that VA fails to reach tens of thousands of
those leaving active duty and most members of the Reserve and
National Guard. Further, the quality of the ratings given those
warriors is often poor.
The VFW began placing National Service Officers on select military installations in 2001. Today, we have nine Pre-Discharge
Claims Representatives serving servicemembers at 16 military installations. We also have National Service Officers in San Juan and
Las Vegas who work at nearby military bases and help
servicemembers who qualify for the BDD and Quick Start Programs. Last year our service officers briefed over 14,400
servicemembers and helped over 8,400 file disability claims. They
received over $9 million in benefits shortly after discharge.
VA reports that it received 51,000 claims from the BDD and
Quick Start programs in 2008, up from 47,000 the year before. Further, it reports that nearly 60 percent of those it briefed filed
claims.
If 51,000 claimants represent 60 percent of those briefed, then
VA is briefing only about 85,000 servicemembers. However, with

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18
over a hundred thousand personnel leaving active duty and another hundred thousand released from the Reserves and National
Guard each year, it is clear that a large number of those who serve
our Nation are not receiving critical information through VAs outreach effort.
The most interesting observation to be made from this data is
that it appears VA is a victim of its own success. While 51,000
claims submitted under the BDD and Quick Start program may
constitute only a small part of VAs annual claims receipt, VA devotes a significant portion of its workforce to educating
servicemembers, as well as developing and rating those claims,
thereby reducing its ability to deal with the rest of the workload.
We do not suggest that VA or DoD lessen their efforts in helping
servicemembers prepare for life after the military. It is absolutely
the right thing to do. However, it is important to recognize that
doing so comes at a cost. We applaud Congress for encouraging
these programs, and we support VA and DoD in their efforts to ensure that every servicemember has an opportunity to adequately
prepare for their lives after discharge.
As we see it, VA has several challenges to resolve if it hopes to
increase the number of servicemembers it reaches and the quality
of the service it provides them.
There are too many servicemembers who are not adequately
briefed about their benefits prior to discharge. Further, VA has
been slow to expand the BDD program to additional installations.
Since 2004, VA has expanded its presence at military bases from
139 to only 153 bases. VA must move more quickly to expand to
other military installations.
Veteran service organizations are critical partners in the BDD
program. VA personnel often do little more than help
servicemembers fill out a claim form. VFW service officers usually
spend an hour with each servicemember, they go through the service treatment records page by page, identifying chronic problems
which may be granted service connection and ensure that those
conditions are documented on the application. Finally, they provide
answers about what to expect in dealing with VA.
As helpful as veteran service officers are, you would think that
DoD would welcome us with open arms. Gaining the permission of
DoD to work on base requires careful and extended negotiations
with both base commanders and the VA. Thats because VA does
not anticipate that service organizations may be able to provide
service officers to help. As a consequence, space, always at a premium, is often difficult to find.
As VA and DoD expand the BDD program to other installations,
we urge them to reach out to veteran service organizations to determine whether were able to provide service officers to help them
help servicemembers.
Finally, in our experience, quality of disability ratings is no better in BDD and Quick Start cases than it is for other veterans. In
November 2009, Winston-Salem, San Diego, and Salt Lake City,
the offices where these claims are processed, had substantive error
rates ranging from 17 to 22 percent. By VAs own admission, and
we view these numbers with a great deal of suspicion based on our
own experience, one out of every five decisions it makes are wrong.

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19
There are 29 Members in the House Veterans Affairs Committee. If you all submitted claims for benefits from the VA, nearly
six of you would have ratings which were in error.
We encourage Secretary Shinseki and his management team to
focus this year on changing the culture in the Veterans Benefits
Administration (VBA) so that quality is the rule not the exception.
I thank you for this opportunity to testify on these important
programs, and I look forward to answering any questions you may
have.
[The prepared statement of Mr. Manar appears on p. 40.]
Mr. HALL. Thank you, Mr. Manar.
Mr. Kelley, you are now recognized.

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STATEMENT OF RAYMOND C. KELLEY

Mr. KELLEY. Thank you, Mr. Chairman. Due to time constraints,


Im going to limit my discussion to the BDD program only.
Despite the fact that tens of thousands of servicemembers have
used the BDD program at more than 150 locations, there are issues
that must be addressed to improve the program, not only for the
veterans who utilize it, but also for DoD and VA. If there continues
to be impediments and inconsistencies in the departments that facilitate the program, its value will be lost.
The concept of a single separation physical seems simple enough;
however, physicals can be facilitated by either DoD, VA, a contractor, or a combination of the three. The national agreement between VA and DoD sets guidelines for local MOUs that will determine who will be responsible for the physical. However, there have
been some challenges at the local level in communicating and following the content of the local MOU.
A 2008 GAO report found that more than half of all BDD intake
sites visited had challenges in administering a single comprehensive exam. Often it was the lack of communication that failed to
reach DoD personnel at the lowest level, therefore, duplicate exams
continued to take place. Often local leadership and commands did
not understand the program, and, therefore, ignored the MOU and
continued to administer two exams.
Resources were also identified as a challenge for local BDD facilities. In some locations, DoD physicians were not qualified to conduct exams that would meet both DoD and VA requirements. In
other locations when DoD is required by the local MOU to conduct
the exam, no provisions were put in place to accommodate the increase in time and resources it would take to conduct the exam.
These and other issues make it difficult for bases offering BDD
to meet time frames set by the program. These MOUs must be disseminated and understood by all personnel who are effected by the
MOU to insure proper implementation. Also, if there are implementation issues, the MOU must be revised to better meet the needs
of the BDD sites.
Because VA does not control or enforce the local BDD sites,
AMVETS believes VA cannot expectcannot be expected to account BDD development time in their timeliness of claims process.
However, AMVETS believes it is important to track the BDD process from intake so efficiencies can be identified and best practices
can be developed. A plan should be put in place that will allow VA

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20
to track the development process of BDD claims and conduct periodic reviews so efficiencies can be determined.
Enforcinginforming servicemembers of this program continues
to be difficult. Again, local commands understanding and support
for the program greatly affect participation. If the military command does not see the value in the program, they will not be as
likely to disseminate the information to the troops. VA and DoD
must make a concerted effort to educate base command structures
so there will be a buy-in to the program.
The Transition Assistance Program should be an excellent way
to communicate the BDD program to transitioning servicemembers,
as well. However, only the Marine Corps mandates that TAP participatesparticipants attend the VA presentation. Since this portion isnt mandatory, servicemembers have the perception it isnt
important, leading to low participation. The VA benefits portion of
TAP should be mandatory.
AMVETS also believes each regional office should have the authority to rate BDD claims. We understand that as a pilot program,
it was practical to have only two offices rate these claims. But now
with more than 150 intake locations, allowing ROs to rate claims
should increase the timeliness of adjudication.
AMVETS is also concerned that BDD enrollees must fill out different formsBDD enrollees must fill out a different form than
veterans who file a traditional claim. These are stark differences
in the two formsthere are stark differences in the two forms,
most notably the length of the form and the depth of the questions
asked. The BDD form is shorter and lacks instructions. Also the respondents burden of time for filling out the BDD form is half of
that of the traditional form. This is due, in part, to the degree of
explanation that is required. For example, each form asks the veteran to state what disabilities they are claiming. The BDD form
provides a small block with only four notebook-style lines for the
veteran to state their claim. But in the traditional form, the veteran is provided with an entire page asking for specific details. A
study must be conducted to determine if providing servicemembers
with a reduced form has any adverse effects on the development
and the final rating of these claims.
Mr. Chairman, this concludes my testimony. And I will be happy
to answer any questions that you have.
[The prepared statement of Mr. Kelley appears on p. 42.]
Mr. HALL. Thank you, Mr. Kelley.
Mr. Wilson, you are recognized for 5 minutes.

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STATEMENT OF JOHN L. WILSON

Mr. WILSON. Thank you, sir. Mr. Chairman and Members of the
Committee, I am glad to be here today on behalf of the Disabled
American Veterans to address the Department of Veterans Affairs
Benefits Delivery Discharge and Quick Start programs.
VA and DoD collaboration to establish single separation exam
programs has generally been successful. According to a GAO report
entitled, Better Accountability and Access Would Improve the
Benefits Delivery at Discharge Program, of September 2008, and
the February 2010 GAO report on the same subject, veterans may
begin receiving benefits within 2 to 3 months instead of the typical

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21
6 or 7 months if they had applied after discharge under the traditional disability claims process.
While the programs can generally be viewed as successful, there
are concerns with performance measures and program management. For example, VAs FY 2009 Performance and Accountability
Report, or PAR, has only one supporting measure for BDD and
Quick Start. It does not separate BDD and Quick Start data despite their specific eligibility differences and population focus. VA
also does not include BDD claim development time, as a rule, as
was discussed earlier.
While the timeliness of receipt of benefits after discharge is useful, excluding the time spent on development of claims makes it
difficult to correct negative trends and adopt positive ones. This
most recent GAO report draws the same conclusion as Disabled
American Veterans.
An important next step for a seamless transition of all military
personnel would be implementation of a mandatory single comprehensive medical examination in order to complete military separation. It seems logical.
The DoD and VA have made positive strides in transitioning our
Nations military to civilian lives and jobs at their work with the
Department of Labors Transition Assistance Program and Disabled
Transition Assistance Program. These TAP and DTAP programs
have improved but challenges remain. The prospect of a servicemember after multiple deployments returning stateside to be
placed on medical or administrative hold has dissuaded some from
going to these briefings and from filing disability claims. Also,
while receiving information has improved, quick processing time
may allow some individuals to fall through the cracks. This is of
particular concern for DTAP participants where those with severe
disabilities may already be getting health care from a VA spinal
cord injury center despite still being on active duty. Since they are
no longer located near a military installation, they are often forgotten in the transition systems process. DTAP has not had the same
level of success as TAP, and closer coordination from the DoD, VA,
and VETS is critical to improving this disparity.
In conclusion, the BDD and Quick Start programs are a generally effective tool. Their effectiveness could be even greater
should the DoD and VA incorporate our suggestions.
It has been a pleasure to appear before you this afternoon. I will
be happy to answer any questions you may have.
[The prepared statement of Mr. Wilson appears on p. 43.]
Mr. HALL. Thank you very much, Mr. Wilson. And I will ask
each of you to answer this, if you would. Both BDD and Quick
Start are generally considered to be successful programs and good
ideas. That being said, if there was one thing you would change in
these programs, what would it be? Mr. Tarantino.
Mr. TARANTINO. Mr. Chairman, I think you are correct. They are
excellent programs, and they are great ideas. The fact that it took
12 years just to get to the not-quite full implementation is a little
bit insane.
I think if I would change that, I would roll it out completely, and
I would make sure that every single servicemember knows that
these programs exist and are able to easily apply for them, that it

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is command supported, and its part of transition assistance, not


just 60 or 90 days out, but 6 months to a year out when they are
actually looking at that decision, thinking about their retention options.
Mr. HALL. Thank you. Mr. Manar.
Mr. MANAR. Well, I could say, Ditto, but let me expand on a
couple of other things, and that is quality. As I spoke earlier, quality is really poor in the VA rating program. And I think if we could
change one thing, it would be that the quality of rating decisions
be improved substantially.
No one in this room would even think about buying a car, for instance, where 20 percent of its parts were defective or where you
had a chance that one out of every five cars would stop working
as soon as you left the dealership.
So I think the VAthe one thing we need here is vastly improved quality of rating decisions.
Mr. HALL. Mr. Kelley.
Mr. KELLEY. I think that, to continue to add, having MOUs at
the local level that work and insuring that those MOUs work. So
if the DoD is tasked with providing these physicals, that, okay,
thats what the MOU says, but do they have all the resources that
they need on that base to facilitate that in a timely manner and
with the resources that they need? And I think thats the biggest
thing, and perhaps educating DoD leadership on the importance of
this BDD program.
Mr. HALL. Mr. Wilson.
Mr. WILSON. Building on that, I would say mandatory physical
exams. For active duty personnel, its not a problem. For the Guard
and Reserve, demobilization makes this difficult. But nonetheless,
the resources should be made available to keep every Guardsman
or Reservist on active dutyon active duty orders until they are
able to get their separation physicals. At that time, and only then,
should their paperwork be certified and they are eligible to then
separate from the service.
Mr. HALL. Okay. Thank you so much for your testimony. You
have been most helpful. We will submit more questions to you in
writing, if you dont mind. And I think we can move on with the
information you have given us, and go to our final witness before
these votes are called.
So Mr. Tarantino, Mr. Manar, Mr. Kelley, and Mr. Wilson, you
are all excused. Thank you, again, very much, for your service to
our veterans.
Our third panel now consists of Diana Rubens, Associate Deputy
Under Secretary for Field Operations, Veterans Benefits Administration, U.S. Department of Veterans Affairs, accompanied by Mr.
Bradley Mayes, Director of Compensation and Pension Service at
the VBA, U.S. Department of Veterans Affairs. Thank you both for
your patience and thank you to all of our previous witnesses for
their concise testimony.
Ms. Rubens, welcome and you are now recognized.

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STATEMENT OF DIANA RUBENS, ASSOCIATE DEPUTY UNDER


SECRETARY FOR FIELD OPERATIONS, VETERANS BENEFITS
ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS; ACCOMPANIED BY BRADLEY G. MAYES, DIRECTOR,
COMPENSATION AND PENSION SERVICE, VETERANS BENEFITS ADMINISTRATION, U.S. DEPARTMENT OF VETERANS AFFAIRS

Mr. RUBENS. Thank you, Mr. Chairman. Thank you for your support on the issues for veterans benefits.
It is my pleasure today to discuss our ongoing nationwide Benefits Delivery at Discharge and Quick Start pre-discharge programs.
As you mentioned, Mr. Mayes has joined me here today.
These two programs are really just elements of our strategy to
provide that transition assistance to separating or retiring
servicemembers and to engage those servicemembers in the claims
process prior to discharge. A pre-discharge claim is any claim received from a servicemember prior to release from active duty.
VBAs goal is to ensure that each and every servicemember separating or retiring from active duty who wishes to file a claim with
VA for a service-connected disability benefit will receive assistance
in doing just that.
We have talked a lot about the fact that the BDD program is
open to servicemembers who are within 60 to 180 days of being released, as well as the Quick Start being available to those
servicemembers with 59 days or less prior to separation.
One of the things that I think is interesting is that during the
fiscal year 2009, our BDD and Quick Start claims may have represented just 20 percent of all our original compensation claims received nationwide. But during the same period, approximately 65
percent of separating servicemembers who filed their claims within
1 year of separation came through the BDD and Quick Start programs. So we think that our profile using these programs has been
high. We know that wed like to improve it, but we think were
doing pretty well at this point.
The timeliness for our processing for both BDD and Quick Start
claims is much better than our general workload, and we believe
that that is because we are getting that head start on the claim
before that servicemember gets out of the Service.
As mentioned previously, one of the things that we have worked
to do is streamline the process by incorporating an imaging technology for the paperless processing of the BDD claims. Our BDD
paperless processing began initially as a pilot in the WinstonSalem Rating Activity Site in March of 2006, and was expanded to
the Salt Lake Rating Activity Site in March of 2007. The goal was
to paperlessly process our BDD claims through the entire life cycle
from initial submission through adjudication and, if applicable,
through the appeals resolution. The advantage to processing BDD
claims in a paperless environment included reduction of time and
cost associated with shipment of folders. In August of 2008, we
began ensuring that all BDD claims were being sent to our scanning vendor so that they could be incorporated into the paperless
environment.
Talking about the environment that we are using today, what we
recognize is that our existing Virtual VA architecture and configu-

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24
ration are not scalable for all C&P processing. Currently we are developing the Veterans Benefits Management System as an initiative to establish our large-scale effort so that we have an IT solution that will allow us to do all processing within that paperless
environment.
We have talked quite a bit about the outreach efforts and the
things that we are doing jointly with DoD to ensure that
servicemembers prior to release are getting information. In addition to having those brochures, the Web sites, and the folks out at
the TAP and the DTAP sessions, I want to touch on the fact that
we are continuing to expand the number of servicemembers we are
reaching. In fiscal year 2008, there were roughly 300,000
servicemembers that, through the myriad or programs we have, received information on benefits prior to discharge. In fiscal year
2009, that number exceeded 360,000. So we are looking to continue
to increase that exposure to ensure all servicemembers released
from active duty are aware of the benefits that they have so richly
earned.
I am going to conclude with renewing our commitment to providing efficient and timely service to our Nations veterans. We continue to evaluate the BDD and Quick Start programs to look for
those improvements that we can accomplish with current technology, as well as new technology to further enhance benefits delivery under these important programs and to improve the veterans
experience.
This concludes my testimony. I would be pleased to answer any
questions you might have.
[The prepared statement of Ms. Rubens appears on p. 47.]
Mr. HALL. Thank you, Ms. Rubens. You are onto something, you
and Mr. Mayes. And I think we are all impressed with the potential and also with what has been realized already with these programs.
Your testimony points out that 65 percent of separating
servicemembers who filed their claims within 1 year did so through
BDD and Quick Start. My first question is would there be a benefit
to keeping statistics of BDD and Quick Start utilization separately?
Mr. MAYES.. Mr. Chairman, we are tracking the utilization, in
other words, service personnel that are separating and filing their
claims through the BDD program or the Quick Start program as
a ratio of all of those servicemembers that are filing claims within
a year. That is one of the things that we have worked with the Department of Defense to come up with a utilization rate measure. So
we are doing that.
And we have seen it increase through the years, as Ms. Ruben
pointed out in her testimony, which we believe is a measure of the
success. To me that says that we are getting the word out. The
commands are making the servicemembers available. As you mentioned, and I think Under Secretary Koch mentioned, for the Marine Corps it is mandatory. We are continuing to push that through
our collaboration with DoD through the Benefits Executive Council
and the Joint Executive Council.
So those are the kinds of things that we are doing, as you mentioned, in improving utilization.

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25
Mr. HALL. Right. Excuse me. Theres 12 minutes left on the vote,
and I just want to ask you a couple more questions, and then we
will submit further questions in writing. But what do you think accounts for the other 35 percent who do not participate in the program?
Mr. RUBENS. I would tell you that I think that there are some
servicemembers who, as they get out, feel as though they are
healthy, that their period of service hasnt brought them to the
point where they need to submit a claim.
Mr. HALL. Okay. And thank you. Sounds like a reasonable assumption for many of them. We understand that there are 142
BDD sites. Are there qualified physicians available to do BDD
exams at all those sites?
Mr. MAYES. There are actually 131 sites that are covered by a
formal Memorandum of Understanding, 95 total MOA. We are
doing the single separation exam at 153 sites. So there is capacity
to do those single separation exams at all of those sites. As we
mentioned, and I think you mentioned in your opening statement,
servicemembers can still file claims through the Quick Start program even if they cant get the single separation exam at that site.
Mr. HALL. What help can we in Congress give you to expand
BDD and Quick Start?
Mr. MAYES. Mr. Chairman, I think that Congress help us get the
word out. We delivered pamphlets. You clearly have a good grasp
of the program. I think that is helpful. When your staff and your
local offices understand this program, they have an opportunity to
interact with veterans, Guard, and Reserve units, helping us to
continue to do that.
And as Under Secretary Koch said, us presenting here before you
and answering these questions forces us to take a look at what we
are doing. We are going to continue to collaborate with the Department of Defense to push so that we have access to active duty and
Guard and Reserve members service personnel before they get out.
We would love to see mandatory TAP so that we have that opportunity to educate people that are leaving the service.
Mr. HALL. Thank you, Mr. Mayes. And I have one last question
is regarding the GAO report, which noted a failure to effectively
track the accuracy of claims that are processed through these specific programs. Does the VA view this as a significant concern and
are there any potential complications involved in tracking these
programs separately?
Mr. MAYES. We do look at a valid sample of decisions requiring
a rating determination for each regional office around the country.
It is a valid sample, 256 cases per regional office per year. That
would include the Rating Activity Sites at Winston-Salem, Salt
Lake, and the site in San Diego.
So within that sampling are cases that are worked through the
BDD program. All of the sites where there is consolidated processing actually had higher quality on average than the nationwide
average. So we felt that through that National Quality Assurance
Program that we were capturing how well they make an entitlement determination. In the end, the entitlement determination for
a BDD or a Quick Start claim is grounded in the same require-

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ments, the same regulations, the same rules as any other claim. So
we felt we were properly evaluating the quality for those sites.
Mr. HALL. Well, thank you, Ms. Rubens and Mr. Mayes, for your
work for our veterans and servicemembers and for your testimony
today. The Subcommittee may have further questions that we will
submit in writing to you. Those Members who were unable to be
here today may have questions, but I want to note that there are
5 legislative days for other Members to make remarks or submit
questions for the record. And thank you to all of our witnesses
today.
This hearing is now adjourned.
[Whereupon, at 3:27 p.m., the Subcommittee was adjourned.]

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A P P E N D I X

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Prepared Statement of Hon. John J. Hall, Chairman,


Subcommittee on Disability Assistance and Memorial Affairs
Good afternoon.
Would everyone please rise for the Pledge of Allegiance? Flags are located at the
front and back of the room.
Ladies and gentlemen, we are here today to examine the Benefits Delivery at Discharge (BDD) and Quick Start programs, two components of the pre-discharge program established by the Departments of Defense (DoD) and Veterans Affairs (VA)
to streamline servicemembers transition from active duty to veterans status.
By way of background, any member of the Armed Forces who has seen active
dutyincluding those in the National Guard or Reservesis eligible to apply for VA
disability benefits prior to leaving military service through the BDD program or
Quick Start pre-discharge program. During the application process, servicemembers
can get help in completing forms and preparing other required documentation from
VA personnel located at their bases. Additionally, this pre-discharge program combines the health exam required by the DoD upon exiting the military and the VA
disabilities assessment exam into a single exam.
Once a BDD or Quick Start claim is approved, veterans may begin receiving benefits within 2 to 3 months, instead of the 6 to 7 months it would typically take if
they had applied after discharge under the traditional disability claims process.
Participation in the BDD program is open to servicemembers who are within 60
to 180 days of being released from active duty and who are able to complete their
scheduled VA medical examinations prior to leaving their points of separation. The
Quick Start program is available to servicemembers within 1 to 59 days of separation from service or servicemembers who do not meet the BDD criteria requiring
availability for all examinations prior to discharge.
The BDD program started as a pilot program in 1995 at three Army bases and
three VA regional offices. In 1998, VA and DoD fully rolled out the BDD program.
Last Congress, my friend Rep. Peter Welch (DVT) introduced H.R. 2259, legislation to expand the BDD program to members of the National Guard and Reserves
which was incorporated in the National Defense Authorization Act for 2008 (P.L.
110181). This statute ensures that Guardsmen as well as Reservists can participate in the VA/DoD pre-discharge program.
In the past 15 years, over 170,000 servicemembers have availed themselves to
BDD and QuickStart processing. The programs have expanded from 3 military bases
to more than 153 locations in the United States, Germany, and South Korea.
According to VA, the majority of pre-discharge claims, 46,856 processed in 2009,
were processed in a paperless environment, with an average processing time of 95.5
days. It is VAs stated goal to be processing all compensation and pension claims
in a paperless environment. The Subcommittee is committed to helping VA
achieve this goal.
I, along with Congressman Rodriquez, and other Members of this Committee and
Congress, requested that GAO prepare a report to assess the effectiveness of the
BDD and Quick Start initiatives. I look forward to hearing from the GAO about its
report, how its recommendations have been implemented, and what, if any impact
they have had on the pre-discharge program.
We also look forward to feedback from veteran service organizations as well as
from VA and DoD on what if any resources are needed to fully realize the potential
of these two tools.
The examination of VA and DoDs pre-discharge program follows up our last hearing concerning the implementation of the Veterans Benefits Improvement Act of
2008, which was codified in P.L. 110389. P.L. 110389 paved the way for a number
of initiatives also targeting the VA claims backlog issue. It is my hope that the BDD
and Quick Start programs we examine today, coupled with the electronic claims system and other business reformation efforts in P.L. 110389 currently underway at
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VA will together help significantly transform todays VA claims processing system
so that we may soon play Taps for the VA comp & pen backlog.
I now recognize Ranking Member Lamborn for his opening statement.
f
Prepared Statement of Hon. Doug Lamborn, Ranking Republican
Member, Subcommittee on Disability Assistance
Thank you Mr. Chairman,
And welcome everyone, to this hearing on the Benefits Delivery at Discharge and
Quick Start programs.
These programs are modeled on the concept of providing a seamless transition
from military service to civilian life.
I, along with Chairman Hall, my fellow Subcommittee Members, and many of you
here, are long-time advocates for creating a seamless transition.
Therefore Im sure we can all recognize the inherent value of beginning the VA
claims process while service medical records are readily available and proof of service connection is easily established.
Allowing veterans to file VA compensation claims prior to separation from active
duty, is simply a logical approach.
BDD is more efficient than the traditional VA claims process and it eliminates
many problems that are created by the time gap that often exists between discharge
and application for benefits.
Among the requirements to establish eligibility for VA compensation, veterans
must be able to show that a condition was incurred during service, and that there
is continuity of treatment between that incurrence and the current condition for
which they are filing.
Obviously, with BDD there is no time gap, so it alleviates the need to show continuity of treatment.
This saves both the veteran and VA a lot of time and effort obtaining private
treatment records.
One can imagine that such efforts can become quite extensive for claims filed several years subsequent to service.
In 2008, full Committee Ranking Member Steve Buyer requested a U.S. Government Accountability Office assessment of the BDD program.
GAOs findings confirmed that allowing claims to befiled prior to discharge is
more efficient than the traditional VA claims process.
While I am optimistic about the overall assessment of the program, I encourage
VA to make every effort to improve the program and increase access to BDD sites.
I believe that processing as many claims as possible in this manner will have a
positive impact throughout the entire systemThank you, I yield back.
f
Prepared Statement of Daniel Bertoni, Director, Education, Workforce, and
Income Security Issues, U.S. Government Accountability Office
VETERANS DISABILITY BENEFITS
Opportunities Remain for Improving Accountability for and Access to
Benefits Delivery at Discharge Program
GAO Highlights

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Why GAO Did This Study


Through the Benefits Delivery at Discharge (BDD) program, the Department of
Veterans Affairs (VA) collaborates with the Department of Defense (DoD) to streamline access to veterans disability benefits by allowing some servicemembers to file
a claim and undergo a single collaborative exam process prior to discharge. BDD
is designed for servicemembers with conditions that, while disabling, do not generally prevent them from performing their military duties. This program can shorten the time it takes for veterans to receive benefits by several months.
GAO was asked to discuss issues surrounding VAs and DoDs BDD program and
related Quick Start program, and identify ways VA and DoD could improve these
programs for transitioning servicemembers. This statement is based on GAOs September 2008 report (GAO08901) that examined (1) VA efforts to manage the BDD
program and (2) how VA and DoD are addressing challenges servicemembers face

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in accessing the BDD program. GAO updated some information to reflect the current status of claims processing and improvement initiatives in the BDD program.
What GAO Found
Although VA awards disability benefits more quickly under BDD than through its
traditional disability claims process, gaps in program management and accountability remain. For example, VA does not separately measure the total time its personnel spend developing BDD claims. As a result, VA has limited information on
potential problems and improvement opportunities regarding BDD claims. GAO continues to believe that VA should measure BDD development time; however, VA told
GAO it has no plans to capture this information. GAO also found that VA implemented two initiatives to improve the BDD programi.e., consolidating BDD processing in two offices and instituting paperless processing of BDD claims to increase
efficiencies and improve security of informationbut did not evaluate whether or
the extent to which desired improvements resulted. Finally, GAO found that VA
was not completely or consistently monitoring BDD operations at all locations. VA
has since taken steps to review BDD operations at more sites and has revised its
protocols to ensure more consistent reviews of BDD operations.
VA and DoD have taken steps to improve servicemembers access to the BDD program; however, opportunities remain for further improvement. For servicemembers
such as National Guard and Reservists who are generally unable to complete the
BDD claims process within the required time frame, VA established an alternative
predischarge program called Quick Start. Under this program, servicemembers may
still initiate a disability application prior to discharge, but can complete the claims
process, including medical exams, at another location after discharge. In response
to GAOs recommendation, VA has taken steps to collect additional data to determine the extent to which the Quick Start program is helping those with limited or
no access to the BDD program. However, as with BDD claims, VA told GAO it has
no plans to measure time spent developing these particular claims, and GAO continues to believe it should. VA and DoD have coordinated to increase BDD program
awareness through VA benefits briefings for servicemembers, and DoD established
a goal that 85 percent of servicemembers attend these non-mandatory briefings.
GAO continues to believe that DoD should establish a plan with a specific time
frame for meeting this goal, but DoD has not developed such a plan. Finally, GAO
found that some bases faced difficulties maintaining local agreements intended to
prevent redundancy and inconvenience for servicemembers in obtaining required
medical exams. In response to GAOs recommendation, DoD reported that it is working with VA to identify best practices to address local challenges to implementing
their cooperative exam process.

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Mr. Chairman and Members of the Subcommittee:


I am pleased to have the opportunity to comment on the Benefits Delivery at Discharge (BDD) program and related Quick Start program, which are administered by
the Department of Veterans Affairs (VA) in collaboration with the Department of
Defense (DoD). Both programs are intended to help servicemembers transition from
military service to life as civilians and veterans by allowing them to initiate their
VA disability benefits applications while they are still in the military. The BDD program further allows servicemembers to go through one collaborative examination
process that satisfies DoDs requirement to determine their general health and VAs
requirement to assess any claimed disabilities, instead of separate exam processes
for both DoD and VA. Under BDD and Quick Start, veterans should begin receiving
benefits sooner than the 6 to 7 months it would typically take if they had applied
after discharge under the traditional disability claims process. Both programs are
designed for servicemembers with conditions that, while disabling, do not generally
prevent them from performing their military duties.1
You asked us to discuss issues surrounding VAs and DoDs BDD program and
related Quick Start program, and identify ways VA and DoD could improve these
programs for transitioning servicemembers. My statement draws on our prior work,
which examined (1) VA efforts to manage the BDD program and (2) how VA and
DoD are addressing challenges that servicemembers face accessing the BDD pro1 The military has a separate disability evaluation process for servicemembers who are being
discharged because they can no longer perform their duties because of a disabling condition.

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gram,2 and was conducted in accordance with generally accepted government auditing standards. We have updated some information to reflect the current status of
VA claims processing and improvement initiatives in the BDD program.
In summary, we found that although VA awards compensation more quickly
under BDD than through its traditional disability claims process, there are gaps in
program management, accountability, and access. For example, VA does not track
time spent developing a BDD claim prior to the servicemembers discharge and
therefore lacks information on how efficiently its personnel are developing BDD
claims. In addition, although VA and DoD have made efforts to improve all
servicemembers access to the BDD program, we identified additional opportunities
to help improve access. For example, VA established the Quick Start program
whereby servicemembers unable to complete exams within BDDs required time
framessuch as National Guard and Reservesmay at least initiate a disability application prior to discharge.3 However, VA lacked sufficient data to determine
whether the Quick Start program was helping those with no or limited access to
the BDD program. In response to our recommendation, VA has updated its data system to track participation by National Guard/Reserves. We also found that efforts
to raise awareness about the BDD program may not reach all those who are eligible.
DoD has set a goal that 85 percent of servicemembers attend Transition Assistance
Program (TAP) sessions, but it has not implemented our recommendation to establish a plan with a specific time frame to meet this goal, and we continue to believe
that it should.
Background

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Through its disability compensation program, VA pays monthly benefits to veterans with service-connected disabilities.4 Under VAs BDD program, any member
of the armed forces who has seen active dutyincluding those in the National
Guard or Reservesmay apply for VA disability benefits prior to discharge. The
program allows veterans to file for and potentially receive benefits earlier and faster
than under the traditional claim process because medical records are more readily
accessible and key forms needed to process the claim can be signed immediately.
Establishing that the claim is related to the members military service may also be
easier under the BDD program because the member is still on active duty status.
In 2008, VA and DoD offered the program at 142 bases,5 providing access to over
70 percent of servicemembers who were discharged in fiscal year 2007.6 In July
2008, VA issued policy guidance allowing servicemembers being discharged from
any military base to initiate BDD claims at other locations where VA personnel
were located, such as at all of its 57 regional offices. VA also established an alternative predischarge program, now called Quick Start, to provide members who cannot participate in the BDD program an opportunity to initiate claims before discharge. Last year, over 51,000 claims were filed through the BDD and Quick Start
programs.
To participate in the BDD program, servicemembers generally must meet six requirements: (1) be in the process of being honorably discharged from military service, (2) initiate their application for VA disability benefits between 60 and 180 days
prior to their discharge date, (3) sign a Veterans Claims Assistance Act (VCAA)
form,7 (4) obtain and provide copies of their service medical records to local VA personnel, (5) complete a VA medical exam, and (6) remain near the base until the
exam process is done. The 60- to 180-day time frame is intended to provide sufficient time prior to discharge for local VA personnel at BDD intake sites to assist
members with their disability applications, including scheduling exams.
While VA has examination requirements for those applying for disability compensation, DoD also has examination requirements for those leaving military serv2 GAO, Veterans Disability Benefits: Better Accountability and Access Would Improve the
Benefits Delivery at Discharge Program, GAO08901. (Washington, D.C.: Sept. 9, 2008).
3 At the time of our review, VA referred to this program as its new, alternative predischarge
program. Today, this program is referred to as the Quick Start program.
4 The amount of disability compensation depends largely on the severity of the disability,
which VA measures in 10 percent increments on a scale of 0 percent to 100 percent. In 2010,
basic monthly payments for veterans with no dependents have ranged from $123 for 10 percent
disability to $2,673 for 100 percent disability.
5 BDD is also present at an additional 11 Coast Guard bases, which are administered by the
Department of Homeland Security.
6 This percentage does not include members of the National Guard or Reserve forces.
7 The Veterans Claims Assistance Act of 2000 (VCAA) (Pub. L. No. 106475) assigns VA the
duty to assist veterans in obtaining any records relevant to their claims, provided the veterans
adequately identify such records so that VA is able to request them.

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ice. For all servicemembers leaving the military, the military services generally require health assessments that consist of a questionnaire about the members general
health and medical history, among other topics. In some cases, members who are
separating from the military may receive a physical exam to obtain evidence for a
particular medical problem or problems that might exist. The purpose of the exam
is to obtain information on the individuals medical history, and includes diagnostic
and clinical tests, depending on the types of disabilities being claimed. VAs exam
for disability compensation is more comprehensive and detailed than the military
services separation exams, which are intended to document continued fitness for
duty, whereas the purpose of the VA exam is to document disability or loss of function.8
Under the BDD program, DoD and VA coordinate efforts to perform exams for
servicemembers being discharged that satisfy requirements of both the military and
VA. Because of variation in the availability of local resources, such as physicians
trained to use VAs exam protocols, DoD and VA agreed that local military bases
should have flexibility to determine whether VA or military physicians or some combination of both will conduct the exam. In 2004, the agencies signed a memorandum
of agreement (MOA) delineating their roles and responsibilities. The national agreement delegates authority to VA regional offices and individual military bases to create memorandums of understanding (MOU) that detail how the exam process will
be implemented at the local level.
VAs Veterans Benefits Administration (VBA) is responsible for administering and
monitoring the BDD program.9 VBA personnel assemble claims-related information
and send the claims to be processed at one of two regional offices.10 VBA is also
responsible for the paperless BDD claims process, an initiative intended to improve
efficiency by converting claims-related information stored in paper folders into electronic format, as part of VAs effort to have all claims processed electronically by
the end of 2012.
VA has established a performance goal to increase the percentage of first-time disability claims filed through the BDD program. Servicemembers generally learn of
the BDD program through VA-sponsored benefits briefings conducted at military
bases as part of TAP sessions. Led primarily by the Department of Labor, TAP consists of about 3 to 4 days of briefings on a variety of topics related to benefits and
services available to servicemembers as they are discharged and begin life as veterans. Generally, servicemembers are required to attend a short introductory briefing, while all other sessionsincluding the VA benefits segment in which members
learn about BDDare optional.
In addition to its participation goal for the BDD program, VA has three general
goals for the timeliness and accuracy of all disability claims: average days pending
(i.e., waiting for a final decision), average days to complete all work to reach a final
decision, and average accuracy rate (percentage of claims with no processing errors).11 In 2009, VA reached its performance goal for one measure, i.e., average days
to complete claims was 161 days compared with a goal of 168 days. However VA
fell short of two goals last year: Average days pending was 117 days compared with
a goal of 116 days, and national accuracy rates were 83 percent compared with a
goal of 90 percent.12
VAs Management of the BDD Program Provides Limited Accountability for
Results, although Recent Improvements Have Been Made
VA Has a Performance Measure for BDD Participation, but Lacks Adequate Measures for Timeliness of BDD Claims

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VA has established one performance measure for the BDD program that tracks
participation in the program. Since fiscal year 2005, VA has tracked the percentage
of all disability claims filed through the BDD program within 1 year of discharge.
8 See GAO, VA and DoD Health Care: Efforts to Coordinate a Single Physical Exam Process
for Servicemembers Leaving the Military, GAO0564 (Washington, D.C.: Nov. 12, 2004).
9 While VA administers the BDD program, VA and DoDs Joint Executive Council (JEC) oversees joint efforts to eliminate barriers that servicemembers may face as they leave the military.
Under the JEC, the Benefits Executive Council is focused on improving information sharing between the agencies and the transition process for servicemembers.
10 In 2006 VA completed its consolidation of BDD processing activities into two regional officesSalt Lake City, Utah, and Winston-Salem, North Carolinato increase the consistency
of BDD claims.
11 VA has several other measures for claims overall, including measures of satisfaction and
how well VA keeps veterans informed of benefits.
12 National accuracy rate data are through July 2009.

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VAs most recent data for fiscal year 2008 indicate that 59 percent of claims filed
within 1 year of discharge were filed through the BDD program9 percentage
points higher than its fiscal year 2008 goal of 50 percent. VA recently revised this
measure so that it accounts only for claims filed by members who are discharging
from bases covered by the BDD program.13
Although VA fine-tuned its measure for BDD program participation, VA does not
adequately measure timeliness of BDD claims. VA tracks the days it takes to process traditional claims starting with the date a veteran first files a claim, whereas
it tracks days to process BDD claims starting with the date a servicemember is discharged.14 This approach highlights a key advantage of the BDD programthat it
takes less time for the veteran to receive benefits after discharge. However, the time
VA spends developing a claim before a servicemembers dischargeat least 60 days
according to VAis not included in its measures of timeliness for processing BDD
claims, even though claims development is included in VAs timeliness measures for
traditional disability claims.15
VA officials told us the agency does not measure the timeliness of BDD claims
development for three reasons: (1) VA lacks legal authority to provide compensation
until a servicemember is discharged and becomes a veteran; (2) VA officials perceive
most development activities, such as obtaining the separation exam and medical
records, to be outside of their control; and (3) VA officials said that a primary objective of the program was to shorten the time from which the member was entitled
to benefitsby definition, after dischargeto the time he or she actually received
them.
While it is useful to know how soon after discharge servicemembers begin receiving benefits, excluding the time VA personnel spend on developing BDD claims limits VAs information on challenges in this stage of the process and may inhibit VA
from taking action to address them. Personnel in 12 of the 14 BDD intake bases
we reviewed indicated significant challenges with claims development activities,
such as scheduling and completing sometimes multiple exams for servicemembers
who leave an area. Challenges such as these may delay the development of
servicemembers claims, putting them at risk of having to drop out of the BDD program. The fact that the servicemember is not yet a veteran does not absolve VA
from tracking the time and resources spent developing BDD claims, which could ultimately help VA identify and mitigate program challenges. As for lack of control
over the claims development process, VA also faces similar limitations with traditional disability claims, because VA must rely on veterans to submit their applications and on other agencies or medical providers for records associated with the
claim. Nevertheless, VA tracks time spent developing these claims and could also
do this for BDD claims.
VA Has Not Fully Evaluated Initiatives to Improve the BDD Program

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VA implemented two initiatives to improve the BDD program but did not fully
evaluate either. In 2006, VA finished consolidating claims processing activities for
BDD into two regional officesSalt Lake City, Utah, and Winston-Salem, North
Carolinato improve the consistency and timeliness of BDD ratings.16 In fiscal year
2007, each office completed about 11,000 BDD claims. Although VA reported to us
that it monitors claims workloads between these offices and, in one case, sent claims
from one office to the other so that claims could be processed more quickly, VA had
not conducted an evaluation to determine whether consistency improved compared
with prior practices.
VA also has not evaluated a second BDD initiative, known as the paperless claims
processing initiative, which is intended to increase the timeliness of claims processing and security of BDD claims information. Since our report, VA told us that
13 Previously, VA had included in the denominator claims from members who were discharged
from non-BDD locations. Using those data, in fiscal year 2007, only 43 percent of first-year
claims were filed through BDD, significantly short of VAs goal. VA will come closer to its goal
by excluding servicemembers who, being from non-BDD locations, will generally be unable to
meet BDD program requirements.
14 While VA lacks a separate performance measure on BDD timeliness, VA officials reported
the agency does track the average days BDD claims are pending a decision and the average
days it takes VA to complete work on BDD claims separately from traditional claims. However,
VA includes only the time after servicemember discharge when tracking BDD timeliness.
15 By not including the time it takes to develop BDD claims, VA underestimates its overall
processing time. However the impact is not large because predischarge (BDD and Quick Start)
claims represent a small portion of all claims processedabout 5 percent in 2009.
16 These two regional offices complete development, rating, award actions, and notification actions for BDD claims.

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all BDD claims have been processed in the paperless environment since August
2008, and that it continues to monitor the BDD paperless initiative by hosting
monthly teleconference calls with all 57 regional offices, intake sites, and area offices to provide ongoing guidance and training, as well as address any issues or
problems the field may be experiencing. However, VA has not evaluated the extent
to which this initiative improved overall timeliness or security.
VAs Review of BDD Operations Has Been Inconsistent, although VA Has Recently
Taken Steps to Improve Monitoring
We identified gaps related to VAs monitoring of the BDD program, but VA has
since taken some steps to address those gaps. For example, we found that between
September 2002 and May 2008, VA conducted reviews of BDD operations in only
16 of the 40 offices it visited. Further, in 10 of the offices that were reviewed, VA
personnel did not document the extent to which BDD claims were fully developed
before being passed on to the processing office, pursuant to VA policy.17 We also
found that the review protocol did not prompt reviewers to verify the extent to
which claims were being fully developed before being sent to the processing office.
In addition, for 14 offices, reviewers did not address whether agreements related to
processing BDD claims existed between the processing office and relevant regional
office, even though VAs BDD operations review protocol specifically prompts reviewers to check for such agreements. In response to our recommendations, VA officials
reported that they have increased the number of BDD oversight visits, including visits to sites that had not been reviewed in several years, such as Honolulu, Hawaii,
and Louisville, Kentucky. Furthermore, VA revised its protocol to require a review
of BDD operations as part of its site visits to monitor regional offices.
VA and DoD Took Steps to Increase Access to the BDD Program, but Some
Servicemembers May Still Face Barriers to Participation
Some Servicemembers Have Limited Access to the BDD Program, but May Participate in the Alternative Quick Start Program

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Although the BDD program is designed to provide most servicemembers with access, some members may be unable to initiate a claim 60 to 180 days prior to discharge or remain within the vicinity of the base long enough to complete their
exams. According to VA officials, this is a challenge particularly for demobilizing
servicemembers of the National Guard and Reserves, who typically remain at a base
for only 2 to 5 days before returning home, and are generally unable in this brief
time to complete requisite exams or obtain required copies of their service medical
records. Servicemembers located in remote locations until just a few days prior to
discharge may also be unable to participate. Finally, we were told that
servicemembers going through the DoD Medical Board process are ineligible for the
BDD program because they typically are not given a firm discharge date in advance
of the 60- to 180-day discharge window, and a firm date is required to avoid
servicemembers returning to active duty after completing the claims process.18
In April 2007, VA established an alternative predischarge program, now known
as Quick Start, to provide members who cannot participate in the BDD program an
opportunity to initiate disability claims before they are discharged. Under this program, local VA personnel typically develop servicemembers claims as much as possible prior to discharge and then send the claims to the San Diego or Winston-Salem
regional offices, which were designated as consolidated processing sites for Quick
Start claims in August 2009.19 In addition, in 2009, VA also created a predischarge
Web site, which allows servicemembers to initiate either a BDD or Quick Start
claim electronically, although exams must still be completed in person.
We found VA lacked data to assess the extent to which servicemembers benefit
from the alternative predischarge program. Specifically, we found that VA was unable to assess participation in the Quick Start program by National Guard and Reserve servicemembers because they could not be distinguished from other
17 VA policy directs the processing offices to have agreements with all of the regional offices
in their jurisdiction to define roles and responsibilities for processing BDD claims.
18 DoD and VA are piloting a program whereby the assessment used to determine a wounded
soldiers fitness for duty can be used to determine VA disability benefits for those ultimately
deemed unfit.
19 These designated processing sites complete development, rating, award actions, and notification actions for Quick Start claims.

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servicemembers.20 In response to our recommendation, the agency reported that it
has updated its data system to distinguish between National Guard/Reserves and
full-time active duty servicemembers who file such claims.
We also found that, like BDD claims, timeliness measures for Quick Start claims
do not include days spent developing the claim prior to discharge. According to VA
officials, the timeliness of Quick Start claims may vary substantially from both BDD
and traditional claims. For example, servicemembers who are on base only a few
days prior to discharge, such as members of the National Guard and Reserves, may
have enough time only to fill out the application before returning home and may
need to schedule the VA exam necessary to fully develop their claim after discharge.
Overall, this will most likely result in less timely receipt of VA disability compensation than through the BDD program, but more timely than traditional claims. On
the other hand, servicemembers with more time before discharge may be able to
complete more or all of the claim development process, including the VA exam. Because VA does not adequately track timeliness of Quick Start, it may be unable to
identify trends and potential challenges associated with developing and processing
these claims. However, as with BDD claims, VA told us it has no plans to measure
time spent developing these particular claims, and we continue to believe it should.
VA and DoD Have Coordinated to Provide Briefings with Information about BDD,
but Military Duties and Other Factors May Hinder Attendance

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VA and DoD have coordinated to provide servicemembers with information about


the BDD program through VA benefits briefings and other initiatives, but attending
these briefings is optional for most servicemembers. According to DoD and VA personnel, most servicemembers learn about the program through VA benefits briefings
conducted as part of TAP sessions, although some may also learn about BDD
through base television spots, papers, and word of mouth.21 However, the Marine
Corps is the only service branch to require servicemembers to attend VA benefits
briefings. For the other service branches, participation requirements may vary by
base and command.
We found that commanders and supervisors support for transition services, such
as VA-sponsored benefits briefings, can vary by base.22 Even though DoD policy requires commanders to allow servicemembers to attend TAP sessions upon the members request, we were told at one base that servicemembers have on occasion not
been released from their duties to attend the briefings, resulting in VA personnel
going up the chain of command to obtain permission for the members to attend. At
two bases, VA officials considered outreach to be difficultbecause of conflicting
missions between VA and DoD and lack of support from some base commanders
resulting often in servicemembers being called away from the briefings.
Although some military officials recommended that servicemembers be required to
attend TAP sessions, rather than mandate attendance, DoD decided in August 2007
to establish a goal that 85 percent of separating servicemembers and demobilizing
National Guard and Reserve members participate in TAP sessions, including VA
benefits briefings. We recommended that DoD establish a plan with a specific time
frame for meeting this goal, but DoD has not developed such a plan. We continue
to believe that DoD should establish a plan for meeting its goal. In the course of
our review, we also learned that TAP participation data may be inaccurate or overstated because unique identifiers were not used to document servicemembers attendance and servicemembers who attend more than one briefing could be doublecounted. Currently, the Department of Labor (DOL), VA, and DoD track participation in their respective TAP sessions separately. We recommended that DoD establish an accurate measure of servicemembers participation in TAP, including VA
benefits briefings. DoD recently reported it is working in collaboration with DOL
and VA to determine what improvements can be made in measuring
servicemembers participation in all components of TAP.

20 At the time of our review, VA also expressed concern that early Quick Start program data
might not be accurate because of to the newness of the program.
21 In addition, the Benefits Executive Councils BDD Working Group has also developed a
BDD and Quick Start pamphlet to be distributed at all VA intake sites, and VAs recently developed predischarge Web site also includes links to the TAP Web site and information.
22 GAO, Military and Veterans Benefits: Enhanced Services Could Improve Transition Assistance for Reserves and National Guard, GAO05544 (Washington, D.C.: May 20, 2005).

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Most BDD Sites Have Local Memorandums of Understanding to Provide a Cooperative Exam Process, but Maintaining Them Has Been a Challenge for Some Bases
Most BDD sites employ local MOUs to establish a cooperative exam process, and
implementation of the exam process varies significantly.23 According to data provided by VA during our review, more than 60 percent of bases offering the BDD program had local MOUs that called for the exclusive use of VA physicians, 30 percent
used VA contractors to conduct exams, and 7 percent used a sequential process involving resources and exams from both VA and DoD.24 At bases offering the BDD
program overseas, VA exams were conducted by physicians under contract with DoD
because VA does not have physicians at these bases.
At several bases we visited, we identified resource constraints and communication
challenges that have affected servicemembers access to the program. Resource challenges we identified at five bases included no designated VA exam provider for more
than 7 months, difficulties hiring physicians, and displaced staff because of construction. At seven bases, we identified communication challenges or a lack of
awareness of the local cooperative exam MOU caused by uncertainties generally resulting from deployment of a key DoD local official or changes in command leadership. In one case, communication between DoD and VA personnel was conducted on
an inconsistent basis, if at all. Such constraints and challenges have caused delays
in servicemembers exams or otherwise made it difficult to meet time frames required by the BDD program.
At the time of our review, DoD and VA had provided some guidance on implementing and maintaining local MOUs; however, personnel in some sites we visited
were interested in learning about promising practices at other bases. We recommended that VA and DoD identify and disseminate information on promising
practices that address challenges local officials commonly face in ensuring
servicemembers have full access to a cooperative exam. DoD officials recently reported collaborating with VA on a September 2009 conference focusing on seamless
transition. DoD officials planned to work with conference sponsors to identify best
practices for dealing with the cooperative exam process as it relates to the challenges local personnel commonly face.
Conclusion
The BDD program appears to be an effective means for thousands of separating
servicemembers to receive their disability benefits faster than if they had filed a
claim under VAs traditional process. Despite BDDs inherent advantages, VA has
not followed through on opportunities to ensure accountability and to optimize results. Similarly, although DoD and VA have made significant progress in increasing
servicemembers access to the BDD and Quick Start programs, opportunities to further ensure or improve access remain. At a time when so many servicemembers are
being discharged with injuries, it is more important than ever to process benefits
as efficiently and effectively as possible. BDD and Quick Start programs have great
potential to achieve these goals, as long as VA maintains a sharp focus on accountability, and both DoD and VA follow through on recommended actions.
Mr. Chairman, this concludes my prepared statement. I would be pleased to answer any questions that you or other Members of the Subcommittee may have.
Related Products

ccoleman on DSK8P6SHH1PROD with HEARING

Veterans Disability Benefits: Further Evaluation of Ongoing Initiatives Could


Help Identify Effective Approaches for Improving Claims Processing. GAO10213.
Washington, D.C.: January 29, 2010.
Veterans Disability Benefits: Preliminary Findings on Claims Processing Trends
and Improvement Efforts. GAO09910T. Washington, D.C.: July 29, 2009.
Military Disability System: Increased Supports for Servicemembers and Better
Pilot Planning Could Improve the Disability Evaluation Process. GAO081137.
Washington, D.C.: September 24, 2008.
23 At the time of our review, 130 of the 142 DoD bases that offered the BDD program had
a local MOU in place; the remaining 12 bases were newer and had not yet established local
MOUs. VA noted that its policy guidance (Fast Letter 0820), signed July 2, 2008, eliminated
the requirement for a local MOU to be in place in order for VA to accept a BDD claim. In this
guidance, VA expanded the definition of a BDD claim, removing the criterion that BDD claims
may be accepted only at military bases where local MOUs are in place.
24 For example, at 2 bases, DoD officials started the exam process by conducting diagnostic
testing, such as hearing and vision tests; a VA physician or contractor conducted the remainder
of the exam, which was then incorporated to meet both VA and DoD separation requirements.

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Veterans Benefits: Increased Focus on Evaluation and Accountability Would Enhance Training and Performance Management for Claims Processors. GAO08561.
Washington, D.C.: May 27, 2008.
Federal Disability Programs: More Strategic Coordination Could Help Overcome
Challenges to Needed Transformation. GAO08635. Washington, D.C.: May 20,
2008.
VA and DoD Health Care: Progress Made on Implementation of 2003 Presidents
Task Force Recommendations on Collaboration and Coordination, but More Remains
to Be Done. GAO08495R. Washington, D.C.: April 30, 2008.
VA Health Care: Additional Efforts to Better Assess Joint Ventures Needed. GAO
08399. Washington, D.C.: March 28, 2008.
DoD and VA: Preliminary Observations on Efforts to Improve Care Management
and Disability Evaluations for Servicemembers. GAO08514T. Washington, D.C.:
February 27, 2008.
Information Technology: VA and DoD Continue to Expand Sharing of Medical Information, but Still Lack Comprehensive Electronic Medical Records. GAO08207T.
Washington, D.C.: October 24, 2007.
DoD and VA: Preliminary Observations on Efforts to Improve Health Care and
Disability Evaluations for Returning Servicemembers. GAO071256T. Washington,
D.C.: September 26, 2007.
GAO Findings and Recommendations Regarding DoD and VA Disability Systems.
GAO07906R. Washington, D.C.: May 25, 2007.
Information Technology: VA and DoD Are Making Progress in Sharing Medical Information, but Are Far from Comprehensive Electronic Medical Records. GAO07
852T. Washington, D.C.: May 8, 2007.
Veterans Disability Benefits: Processing of Claims Continues to Present Challenges. GAO07562T. Washington, D.C.: March 13, 2007.
Veterans Disability Benefits: Long-Standing Claims Processing Challenges Persist.
GAO07512T. Washington, D.C.: March 7, 2007.
High Risk Series: An Update. GAO07310. Washington, D.C.: January 31, 2007.
Veterans Disability Benefits: VA Can Improve Its Procedures for Obtaining Military Service Records. GAO0798. Washington, D.C.: December 12, 2006.
Military Disability Evaluation: Ensuring Consistent and Timely Outcomes for Reserve and Active Duty Service Members. GAO06561T. Washington, D.C.: April 6,
2006.
Military Disability System: Improved Oversight Needed to Ensure Consistent and
Timely Outcomes for Reserve and Active Duty Service Members. GAO06362. Washington, D.C.: March 31, 2006.
VA and DoD Health Care: Opportunities to Maximize Resource Sharing Remain.
GAO06315. Washington, D.C.: March 20, 2006.
Veterans Benefits: Further Changes in VBAs Field Office Structure Could Help
Improve Disability Claims Processing. GAO06149. Washington, D.C.: December 9,
2005.
Veterans Disability Benefits: Claims Processing Challenges and Opportunities for
Improvements. GAO06283T. Washington, D.C.: December 7, 2005.
Veterans Disability Benefits: Claims Processing Problems Persist and Major Performance Improvements May Be Difficult. GAO05749T. Washington, D.C.: May
26, 2005.
Military and Veterans Benefits: Enhanced Services Could Improve Transition Assistance for Reserves and National Guard. GAO05544. Washington, D.C.: May 20,
2005.
VA and DoD Health Care: Efforts to Coordinate a Single Physical Exam Process
for Servicemembers Leaving the Military. GAO0564. Washington, D.C.: November
12, 2004.
Veterans Benefits: Improvements Needed in the Reporting and Use of Data on the
Accuracy of Disability Claims Decisions. GAO031045. Washington, D.C.: September 30, 2003.
f

ccoleman on DSK8P6SHH1PROD with HEARING

Prepared Statement of Hon. Noel C. Koch, Deputy Under


Secretary of Defense (Wounded Warrior Care and Transition
Policy), U.S. Department Secretary of Defense
Mr. Chairman, thank you for inviting me to join you today to discuss how the Department of Defense (DoD) in collaboration with the Department of Veterans Affairs
(VA) is working to increase transitioning servicemembers participation in the Benefits Delivery at Discharge (BDD) and Quick Start Programs. The Departments con-

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37
tinue to work together to address these issues through the auspices of the DoD/VA
Benefits Executive Council and the Joint Executive Council.
The Office of Wounded Warrior Care and Transition Policys (WWCTP) mission
is to ensure Wounded, Ill, Injured & transitioning Warriors receive the highest quality care and seamless transition support. Some of our Wounded, Ill or Injured
servicemembers may be able to return to active duty following their recovery, and
may choose to do so, while others may leave military service. But while in the care
of DoD, it is my offices job to develop policy and provide oversight of several parts
of a servicemembers care, recovery and transition.
As you are aware, one of the most important efforts we made was in response
to the recommendations sent forth by the Presidents Commission on Care for Americas Returning Wounded Warriors and required by the National Defense Authorization Act for Fiscal Year 2008 (NDAA 2008) to provide a single point of contact for
recovering servicemembers and their families. In response to the NDAA requirement, we launched the Department of Defense Recovery Coordination Program
(RCP).
The RCP places Recovery Care Coordinators (RCC) in each Military Departments
Wounded Warrior Program. The RCCs support eligible Wounded, Ill and Injured
servicemembers, including members of the Reserve Component, and their families,
by ensuring their non-medical needs are met along the road to recovery.
My office also has oversight for training the Recovery Care Coordinators. To improve outreach to those supported by an RCC, I had my staff expand the training
curriculum for the DoD Transition Assistance Program (TAP) and its TurboTAP
Web site. RCCs are told how to connect wounded, ill and injured servicemembers
with the BDD and Quick Start Programs through their supporting TAP office. BDD
or Quick Start can now be added to the members comprehensive plan, if applicable.
Servicemembers leaving the military are informed about BDD and Quick Start
during the Pre-separation Counseling phase of the transition process. There are five
components of TAP, namely:
Pre-separation Counselingsponsored by DoD and the Military Services
VA Benefits Briefingssponsored by VA
Disabled Transition Assistance Program (DTAP)sponsored by VA
Department of Labor (DOL) TAP Employment Workshopssponsored by
DOL
One-on-one coaching which occurs following the previously mentioned four
components.
Information on BDD and Quick Start is first provided during the pre-separation
portion of the transition process. These programs are addressed again, in greater
depth, by VA during the VA sponsored VA Benefits Briefing, and a third time during the VA sponsored DTAP. Servicemembers meeting the eligibility criteria are
given a minimum of three opportunities to learn about these vital programs.
Other actions the Department has taken in conjunction with our partners at VA
to educate and inform servicemembers about the BDD and Quick Start Programs
include:
Launched the VA Pre-Discharge Web site in June 2009 and linked it to our
DoD TurboTAP Web site.
Developed a BDD and Quick Start pamphlet.
Promoted BDD and Quick Start on servicemembers Leave and Earnings
Statements (September 2009).
Convened the Joint Interagency Strategic Working Group for the Transition
Assistance Program to assess and update the program.
One outcome was a recommendation that DoD update its DoD Instruction
on Pre-separation Counseling by requiring counselors to cover the BDD
and Quick Start Programs. This policy modification will help us close any
gaps that may exist.
Another outcome was to update the Pre-separation Counseling Checklist
for Active Component and Transitioning Counseling Checklist for Demobilizing/Deactivating Reserve Component Services members by adding
BDD and Quick Start. Although our emphasis is on counseling and coaching servicemembers, it is equally important that we document that counseling was conducted. The forms are the tools which allow us to do that.
Within two weeks following the Joint Interagency Strategic Working
Group meeting, DoD TAP joined the social network community by
launching the DoD TAP Facebook. We are taking advantage of the popularity of social media as another communications resource to promote
transition services and benefits to military personnel and families. One

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of the first links and resources on our Facebook homepage is to the PreDischarge Web site.
So where are we today? What other steps are we taking that will continue to foster our commitment and support to our deserving warriors?
The Department will soon issue a Memorandum to the Military Departments asking senior leaders and commanders at all levels to strengthen their emphasis on the
importance of BDD and Quick Start. We view this Memorandum as a call to action
to our commanders to become more engaged with ensuring eligible servicemembers
submit their claim for disability compensation through BDD or Quick Start before
separating from the military.
As the Co-Chairs of the Benefits Executive Council (BEC), my distinguished colleague, the former Under Secretary for Benefits, and I wanted to institutionalize
and strengthen responsibilities of our Pre-Discharge Working Group, which falls
under our purview. To accomplish this we directed this group to develop a Pre-Discharge Working Group Charter for our approval. I am delighted to report, Mr.
Chairman that I recently signed the Charter as the DoD BEC co-chair and sent it
to my VA Co-chair counter-part, the Acting Under Secretary for Benefits for his signature.
But these programs and actions notwithstanding, much remains to be done. Both
DoD and VA are aware that we can improve how we care for our servicemembers
and Veterans, be it through further research, continuing to ease access to benefits
for those who earned them, and finding more efficient and effective service-delivery
systems that will provide better support for our warriors and their families.
Mr. Chairman, we are reminded daily of our obligation to our servicemembers and
their families, and particularly to the Wounded, Ill and Injured, and those who bear
the greatest burden of caring for them. We are committed to providing the support
they need to help ensure a successful transition through recovery and rehabilitation
and back to active duty or reintegration into their communities.
We appreciate the opportunity to come before you today to discuss a subject which
the Secretary of Defense has said repeatedly is a Departmental priority second only
to the wars in which we are engaged. I will be happy to answer your questions.
Thank you.
f

ccoleman on DSK8P6SHH1PROD with HEARING

Prepared Statement of Thomas Tarantino, Legislative


Associate, Iraq and Afghanistan Veterans of America
Mister Chairman, Ranking Member, and Members of the Subcommittee, on behalf
of Iraq and Afghanistan Veterans of Americas (IAVA) 180,000 members and supporters, I would like to thank you for the opportunity to speak before you today to
express the concerns of our membership on some very important issues facing veterans of Iraq and Afghanistan and their families.
As an OIF veteran with 10 years of service in the Army, I have seen firsthand
the difficulties that many face when transitioning from being a servicemember to
being a veteran. For the wounded warrior, torn from service due to their extraordinary sacrifice, and the young veteran, who spent most of their formative years in
uniform, the transition can be difficult. All too often, we leave behind structured and
accessible care and benefits of the military when seeking care and benefits at the
Department of Veterans Affairs (VA), where were left to our own devices.
In response to the need for a more seamless transition from servicemember to veteran, the VA and Department of Defense (DoD) have embarked on several initiatives that allow servicemembers to walk off post with their benefits in hand. However, the potential of these programs has yet to be fully realized. And their full impact will not be felt until the VA begins aggressive outreach to servicemembers and
the DoD makes transition programs uniform and mandatory.
When I left the Army in 2007, I had no idea of the scope and availability of the
benefits I was entitled to as a veteran. In fact, it never occurred to me to seek benefits and health care from the VA for the general wear and tear of a decade of military service. If it werent for the advice of a Sergeant Major attending the Army
Civilian Alumni Program with me I would never have applied.
But we cannot rely on word of mouth to spread this information. The DoD and
the VA must integrate their outreach and ensure a smooth transition of services before a servicemember is ready to leave the uniform behind. Otherwise, more men
and women will fall through the cracks. The Marine Corps mandates TAPS programs within 90 days of separation, while the Army conducts their Civilian Alumni
Program within 30 days. Both of these programs are useful, but begin far too late
to effectively utilize the Benefits Delivery at Discharge Program. Additionally, nei-

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ther program has comprehensive and mandatory briefings about the availability of
VA services.
The VA must begin to see itself as a military alumni program. Many of us remember the guy from our colleges alumni society who greeted us freshman year and continued to pester us throughout college and for years afterward. It may have been
annoying at times, but the message was communicated clearly and consistently. The
VA needs to be communicating at least that effectively with our veterans. There
should be no excuse for a veteran not knowing what services are available to them
when they separate. Only when the VA integrates its outreach and education efforts
with the DoD will benefits programs reach their full potential.
Early outreach also requires VA boots on the ground. To effectively utilize quick
start services the VA must have a presence at all military installations in order to
provide access and information to the benefits and services that the servicemembers
have earned. Additionally, the VA should offer training to AGR members of the National Guard and reserve in order to educate servicemembers who do not have the
same interaction with the military services as their active duty counterparts.
Just as the VA must rethink the way it conducts outreach, the DoD must understand that it has a responsibility to its servicemembers to set them up for success
whether they retire from service or choose to leave. The military is a lifestyle, not
a job. Those that choose this life must be afforded every opportunity to excel both
while in uniform, and when they put the uniform away. The DoD must mandate
a comprehensive and structured Transitional Assistance Program that integrates
VA benefits and services.
In addition to integrating outreach and training we need to address the expedience and accuracy of the benefits process. The Benefits Delivery at Discharge Program generally provides more accurate and timely benefits to separating
servicemembers than the standard benefits approval process. However, this is largely due to the co-location of the servicemember with their respective records and DoD
medical facility. Many of the processing issues that plague the standard system still
exist. They are mitigated by the fact that the servicemember is still in uniform and
has full access to DoD care and services, while waiting for their rating, thus reducing the time it takes to develop a claim.
Receiving a disability rating at the VA can be a long and confusing process for
a veteran. Often, a veteran must wait for a rating that does not accurately reflect
what they are entitled to. The VA currently uses a disability evaluation process that
was outdated long before many Iraq and Afghanistan veterans were born. This has
lead to a situation where hundreds of thousands of veterans must navigate an antiquated system that focuses on the quantity over quality of the processed claims.
Consequently, 17 percent of cases do not accurately compensate veterans for their
earned benefits. And as we all know, that leads to months, if not years, of delayed
payments.
IAVA applauds some of the innovative initiatives that the VA has undertaken to
mitigate this problem. Two such programs are the pilot that integrates the Virtual
VA into the Benefits Delivery at Discharge process, establishing online information
for quick start programs, and the Six Sigma pilot at the Little Rock Regional Office.
Now it is time to take it to the next level. The Virtual VA is a step in the right
direction, but it must integrate with VHA records if it is to be effective. Informational Web sites are good, but todays veterans expect a Web site to offer services
as well as information.
This year IAVA, along with many of our fellow Veterans Service Organizations,
have selected reform of the disability benefits approval process as our number one
legislative issue. We believe that our veterans and survivors deserve a top quality
disability claims system and we commit to supporting and passing disability claims
reform legislation that:
Develops a work culture at VA that emphasizes quality at all steps by creating a management culture that measures and rewards quality of results,
not just quantity, and provides sufficient training of VAs management and
workforce in order to achieve this outcome.
Modernizes the IT infrastructure and optimizes business processes by creating a secure and accessible paperless IT system which rapidly moves and
organizes the information necessary for VA to approve claims for benefits,
while optimizing workflow and business processes.
Develops a simpler and more transparent application and approval process by
creating a universal and simple application process that provides veterans
with regular updates on the progress of their claims and allows them to access their records and the status of their claims.

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Thank you again for the chance to communicate our analysis and suggestions on
this most important issues facing veterans of Iraq and Afghanistan. We look forward to continuing to work with the committee and I appreciate your time and attention.
f
Prepared Statement of Gerald T. Manar, Deputy Director, National
Veterans Service, Veterans of Foreign Wars of the United States
MR. CHAIRMAN AND MEMBERS OF THE COMMITTEE: On behalf of the 2.1
million men and women of the Veterans of Foreign Wars of the U.S. (VFW) and our
Auxiliaries, we appreciate the opportunity to present our views and concerns regarding the VA Benefits Delivery at Discharge (BDD) and Quick Start Programs.
In 1973, I spent the last two weeks of active duty in the Navy at Treasure Island
in San Francisco Bay. During that entire period I did not hear a single word about
VA disability compensation, VA health care or the GI Bill. My experience was, I believe, not at all out of the ordinary. Other than education benefits, I knew virtually
nothing about the services VA provided to veterans until I was hired by VA in 1974
as a benefits counselor to work on college campuses in the Detroit area.
The world has changed tremendously in the decades since my discharge from the
Navy. DoD and VA have made significant strides to ensure that our newest veterans are better prepared for life after discharge than any generation of veterans
that preceded them. Unfortunately, VA fails to reach tens of thousands of those
leaving active duty and most Reserve and National Guard members. Further, the
quality of the ratings given these warriors is, in a word, awful.
Background
The Transition Assistance Program (TAP) and the Disability Transition Assistance Program (DTAP) was created in the 1980s to better inform servicemembers
about benefits and opportunities following service. Those programs have expanded
significantly so that today, classes and briefings start months before release from
active duty. The TAP and DTAP dont just cover VA benefits. Information on resume
writing, employment counseling, small business information, personal finance, and
much more is provided to soon to be released servicemen and women.
From 20052007, VA briefed over 1 million servicemen and women and interviewed over 318,000.
The BDD initiative is an outgrowth of the TAP and DTAP programs. It began in
1995 as a joint project by VA and DoD at only three Army bases. It has expanded
to over 150 installations covering all branches of service. This program allows
servicemembers within 60 to 180 days of discharge to file a claim for compensation
benefits, receive necessary medical examinations, and obtain a rating soon after release from active duty.
Veterans of Foreign Wars
Veteran service organizations have worked hand in hand with the VA and DoD
to ensure that our nations newest veterans receive every benefit to which they are
entitled under the law.
The VFW began placing national service officers on select military installations
in 2001. Today, we have 9 Pre-Discharge Claims Representatives serving troops at
16 military installations. We also have national service officers in San Juan and Las
Vegas who perform TAP briefings several times a month at nearby military bases
and help servicemembers who qualify for the BDD and Quick Start programs. Last
year our service officers briefed over 14,400 servicemembers and helped over 8,400
soldiers, sailors, airmen and marines file disability claims with VA.
The VFW also has two full time specialists reviewing BDD ratings at the VA regional offices in Winston-Salem and Salt Lake City Rating Activity Sites RAS. All
told in 2009, our small cadre of national service officers helped BDD and Quick
Start participants receive over $9 million in benefits at or shortly after discharge.

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Challenges
VA reports that it received 51,000 claims from the BDD and Quick Start claims
programs in 2008, up from 47,000 the year before. Further, it reports that nearly
60 percent of those it briefed filed claims.
These numbers are fascinating for several reasons. First, that at least 60 percent
believe they were disabled to some degree during their military service is signifi-

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cant. While I do not have the exact numbers, our experience is that nearly all will
receive service connection for at least one disability and most will receive compensation at some level.
Second, if 51,000 claimants represent 60 percent of those briefed, then VA is briefing only about 85,000 servicemembers. However, it is our understanding that each
year over 100,000 personnel leave active duty and another 100,000 are released
from the Reserves and National Guard. While some Reserve and National Guard
personnel use the BDD and Quick Start programs as they depart active duty it is
clear that a large portion of those serving on active duty and in the reserves are
not receiving critical information through VAs outreach efforts.
The most interesting observation is that VA is a victim of its own success. It may
be merely a coincidence but in the mid-1990s at about the time VA expanded its
TAP and DTAP programs, VAs workload began to increase. While 51,000 claims
submitted under the BDD and Quick Start programs may constitute only 5 percent
of VAs annual claim receipts, VA devotes a significant portion of its workforce to
educating servicemembers and encouraging them to file claims. Further, many highly skilled personnel at the Winston-Salem, Salt Lake City and San Diego Regional
Offices have been tasked to work BDD and Quick Start claims exclusively.
We do not suggest that VA or DoD lessen their efforts in helping servicemembers
prepare for life after the military. It is absolutely the right thing; it may not always
be the easiest or cheapest thing. We applaud Congress for encouraging these programs and we support VA and DoD in their efforts to ensure that every servicemember has an opportunity to adequately prepare for their post-discharge life.

ccoleman on DSK8P6SHH1PROD with HEARING

As We See It
VA has several challenges to resolve if it hopes to improve the number of
servicemembers it reaches and the quality of the service it provides them:
There are too many servicemembers who are not adequately briefed about their
benefits prior to discharge. While DoD may require pre-discharge education far
too many servicemembers are either not provided, or find some way to avoid
these programs. Further, VA has been slow to expand the BDD program to additional installations. In 2004, VA was at 139 military bases; in 2008 the number stood at only 150. VA must move more quickly to expand to other military
installations.
Veteran Service Organizations are a critical partner in the BDD program. VA
personnel have neither the time nor, often, the expertise to help
servicemembers fill out more than a claim. VFW service officers usually spend
an hour with each servicemember, talking with them about their problems and
concerns; they go through the service treatment records page by page, identifying chronic problems which originate or are aggravated by military service
and ensure that those conditions are both listed and documented on the application. They accomplish Veterans Claims Assistance Act (VCAA) notification
which helps shorten the development process. Finally, they provide answers
about what to expect in dealing with VA.
As helpful as veteran service officers are you would think that DoD would welcome us with open arms. Gaining the permission of DoD to work on base requires careful and extended negotiations with both DoD and VA. Thats because
VA does not anticipate that service organizations may be able to provide service
officers to help. As a consequence, space, always at a premium, is often difficult
to find.
As VA and DoD expand the BDD program to other installations, we urge them
reach out to Veteran Service Organizations to determine whether we are able to provide service officers to help them help servicemembers.
Finally, in our experience quality of disability ratings is no better in BDD and
Quick Start cases than it is for other veterans. The VA STAR report for November,
2009, shows that 17 percent of all ratings nationally contained at least one substantive error. Winston-Salem met the national error rate, while San Diego, where
Quick Start claims are rated had a 19 percent error rate. Salt Lake City trailed
with a 22 percent error rate. Essentially, one out of every 5 decisions made by VA
are wrong.
There are 29 members on the House Veterans Affairs Committee. If you all submitted claims for benefits from the VA nearly 6 of you would have ratings which
were wrong.
We encourage Secretary Shinseki and his management team to focus this year on
changing the culture in VBA so that quality is the rule, not the exception.

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Aristotle once said: We are what we repeatedly do. Excellence then is not an act,
but a habit.
VA needs to create a culture where excellence is a habit.
f

ccoleman on DSK8P6SHH1PROD with HEARING

Prepared Statement of Raymond C. Kelley, National


Legislative Director, American Veterans (AMVETS)
Chairman Hall, Ranking Member Lamborn, and members of the subcommittee,
thank you for the opportunity to appear before you today to provide AMVETS views
regarding the Benefits Delivery at Discharge and Quick Start Programs.
The Benefits Delivery at Discharge (BDD) program was established to allow
servicemembers to begin their disability claims process prior to discharge. Another
benefit to this program is the servicemembers will receive a single physical that will
satisfy both the requirements for DoD separation as well as VA disability claims assessment. By doing this, servicemembers who are less than 180 days but more than
60 days away from separating from active military service can initiate a VA disability claim. This will allow for a more seamless transition for the servicemember
who may begin receiving disability compensation within one to three months after
discharge as apposed to six to seven months if they file their claim in the tradition
manner.
Despite the fact that tens of thousands of servicemembers have used the BDD
program at more than 150 locations, there are issues that must be addressed to improve the program not only for the veterans who utilize it, but also for DoD and
VA. If there continue to be impediments and inconsistencies for the departments
that facilitate the program, the real value of the program will be lost.
The concept of a single separation physical seems simple enough. However, the
physicals can be facilitated by either DoD, VA, a contractor, or a combination of the
three. The national agreement between VA and DoD set guidelines for local Memorandums of Understanding (MOU) that will determine who will be responsible for
the physical. However, there have been some challenges at the local level in communicating and following the content of the local MOU. The Veterans Disability Benefits GAO report (GAO08901) found that more than half of all BDD intake sites
visited had challenges in administering a single, comprehensive exam. Often it was
a lack of communication that failed to reach DoD personnel at the lowest level,
therefore, duplicate exams continued to take place. Often, local leadership of commands did not understand the program and therefore they ignored the MOU and
continued to administer two physicals.
Resource changes were also identified as a challenge for local BDD facilities. In
some locations DoD is responsible for conducting the exam, but current physicians
were not qualified to conduct exams that would meet both DoD and VA requirements. At other locations, when DoD is required by the local MOU to conduct the
exam, no provisions were put in place to accommodate the increase in time and resources it would take to conduct the exams. These and other issues make it difficult
for bases offering BDD to meet time frames set by the program. These MOUs must
be disseminated to and understood by all personnel who are affected by the MOU
to ensure proper implementation. Also, if there are implementation issues the MOU
must be revised to better meet the needs of BDD sites
Because VA does not control or enforce the local BDD sites, AMVETS believes VA
cannot be expected to account BDD development time in their timeliness of claims
processing. However, AMVETS believes it is important to track the BDD process
from intake so efficiencies can be indentified and best practices can be developed.
A plan should be put into place that will allow VA to track the development process
of BDD claims and conduct periodic reviews so efficiency can be determined.
Informing servicemembers of this program continues to be difficult. Again, local
commands understanding and support for the program greatly affects participation.
If the military command does not see the value in the program, they will not be
as likely to disseminate the information to the troops. VA and DoD must make a
concerted effort to educate base command structures so there will be buy-in of the
program. This is the first step to delivering the information to troops.
The Transition Assistance Program (TAP) should be an excellent way to communicate the BDD program to transitioning servicemembers as well. However, only the
Marine Corps mandates that TAP participants attend the VA presentation. Since
this portion is mandatory, servicemembers have the perception that it is unimportant, leading to low participation. The VA benefits portion of TAP should be mandatory.

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AMVETS also believes each Regional Office (RO) should have the authority to
rate BDD claims. We understand that as a pilot program, it was practical to have
only two offices rate these claims, but now with more than 150 intake locations allowing the ROs to rate claims should increase the timeliness of adjudication.
AMVETS is also concerned that BDD enrollees must fill out VA Form 21526c,
the Pre-Discharge Compensation Claim, while veterans who file a traditional claim
must fill out VA Form 21526. There are stark differences in the two forms. The
two most notable differences are the length of the form and the depth of the questions asked. The BDD forms are four pages shorter and lack the instructions that
are present in the traditional VA compensation and pension form. Also, the respondents burden of time for filling out the BDD forms is half that of the traditional
form. This is due in part to the degree of explanation that is required. For example,
each form asks the veteran to state what disabilities they are claiming. The BBD
form provides a small block with four notebook style lines for the veteran to state
their claim, but in the traditional form the veteran is provided with an entire page
asking for specific details pertaining to each of the veterans claims. A study must
be conducted to determine if providing servicemembers with a reduced form has any
adverse affects on the development and the final rating of these claims.
Mr. Chairman, thank you again for providing AMVETS the opportunity to present
our views on BDD and Quick Start. This concludes my testimony and I will be
happy to answer any questions you may have.
f

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Prepared Statement of John L. Wilson, Assistant


National Legislative Director, Disabled American Veterans
Mr. Chairman and Members of the Committee:
I am pleased to have this opportunity to appear before you on behalf of the Disabled American Veterans (DAV) to address the Department of Veteran Affairs (VA)
Benefits Delivery at Discharge and Quick Start Programs.
The Benefits Delivery at Discharge (BDD) and Quick Start programs provide
servicemembers the opportunity to apply for disability compensation benefits from
the VA prior to retirement or separation from military service. Servicemembers who
leave the military and file disability claims with the VA may be subject to duplicative physical exams in order to meet requirements of both the Department of Defenses (DoDs) military services and VA. To streamline the process, the military
services and VA moved to coordinate their physical exam requirements by developing a single separation exam program. This program found its beginnings in 1995
when VA began accepting disability compensation claims from servicemembers in
the BDD program at three VA regional offices and three Army installations. However, differences in the availability of physicians trained to use VAs exam protocols,
resulted in DoD and VA agreeing that local military bases be given flexibility in implementing the exams by allowing either VA or military physicians to conduct the
exam.
In 1998, VA and DoD signed a memorandum of understanding (MOU) instructing
local units to establish single separation exam programs. In 2002, the agencies created a Joint Executive Council to oversee joint efforts to eliminate barriers
servicemembers face as they leave the military. The Joint Executive Councils Benefits Executive Council, is focused on improving information sharing between the
agencies and improving the transition process for servicemembers. The agencies
signed another memorandum of agreement in 2004, laying out roles and responsibilities for each agency in establishing a cooperative separation exam process. The
signing of the National Defense Authorization Act for Fiscal Year 2008 mandated
BDD services were to also be provided to National Guard and Reserve personnel at
non-traditional BDD sites such as armories, military family support center to the
maximum extent possible.
Participation in the BDD program is offered to servicemembers who are within
60 to 180 days of release from active duty and who remain in the area in order to
complete the medical examinations. To participate in BDD, servicemembers generally must meet six requirements: (1) be in the process of being honorably discharged, (2) initiate their VA disability benefits application between 60 and 180
days prior to discharge, (3) sign a Veterans Claims Assistance Act (VCAA) form, (4)
provide the VA copies of service medical records, (5) complete a VA medical exam,
and (6) remain near the base until all exams are completed. The BDD claims are
then processed at VA Regional Offices at Salt lake City, Utah or Winston-Salem,
North Carolina.

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Quick Start is offered to all servicemembers with less than 60 days remaining on
active duty or demobilization. It is well suited for National Guard and Reserve
members as they can file a claim while attending demobilization briefings and continue the claims process after returning home. This may make it possible for them
to receive VA compensation benefits faster after separation or retirement.
Servicemembers with 159 days remaining on active duty or full-time Reserve or
National Guard (Title 10 or Title 32) or servicemembers who do not meet the BDD
criteria requiring availability for all examinations prior to discharge may apply
through Quick Start. There are three ways to apply for Quick Start: (1) Download
VA Form 21526, Veterans Application for Compensation and/or Pension, from the
VA Web site and submit it to the nearest VA Regional Office or any location where
VA accepts claims; (2) Submit an online application at www.va.gov using Apply Online, then click Compensation & Pension on the drop-down menu; (3) Request a
claim form be mailed by calling the VA toll-free number. The servicemember must
submit a paper copy of their service treatment records with each of the three options.
Current BDD program participants include 40 regional offices and 153 military
installations (142 DoD sites and 11 Homeland Security Coast Guard sites). This
number includes 5 locations overseas (3 in Korea and 2 in Germany). VA also issued
policy guidance that allows servicemembers being discharged from any base to file
BDD claims at all 57 VA Regional Offices and other locations where VA personnel
are located.
The Veterans Benefits Administration (VBA) has also established a Web site of
http://www.vba.va.gov/predischarge/index.htm to provide information on the four
components of the Pre-Discharge Program:
BDD
Quick Start
Disability Evaluation System (Pilot program)
Seriously Injured/Very Seriously Injured (SI/VSI)
The collaboration between the VA and the military services to establish single
separation exam programs has generally been a successful endeavor. According to
a Government Accountability Office (GAO) Report titled Better Accountability and
Access Would Improve the Benefits Delivery at Discharge Program, GAO08901,
September 9, 2008, once a BDD application is approved, veterans may begin receiving benefits within 2 to 3 months, instead of the 6 to 7 months it typically takes
if they had applied after discharge under the traditional disability claims process.
In the past 5 years, about 140,000 servicemembers have used the BDD program.
More than 70 percent of servicemembers leaving the military in fiscal year (FY)
2007 were discharged at military bases offering the BDD program.
A primary advantage of this program is that service treatment records are more
readily accessible to the servicemember and the VA so filing a VA disability claim
through the BDD program can be faster than filing a claim as a veteran under the
traditional claim process. Establishing service connection for a claimed condition
may be easier, since the member is still on active duty status. Key forms needed
to process the claim can also be signed immediately.
While the programs can generally be viewed as successful, there are concerns
with performance measures and program management. For example, VAs FY 2009
Performance and Accountability Report (PAR) has only one supporting measure for
BDD and Quick Start. The PAR supporting measure is out of all original claims
filed within the first year of release from active duty, the percentage filed at a BDD
site prior to a servicemembers discharge. The strategic goal is 65 percent. Results
for each of the fiscal years is as follows: FY 2006 result of 46 percent with a target
of 53 percent; FY 2007 result of 53 percent with a target of 48 percent; FY 2008
result of 59 percent with a target of 50 percent; FY 2009 result is unknown with
a target of 60 percent. While increasing participation seems evident, the measure
references BDD and Quick Start together, despite their very specific differences.
Since both programs are measured in a combined fashion, it is difficult to determine
the utilization rates of the two programs. Also, there is no breakout by Service component making it difficult to determine the number of National Guard and Reservists who are using these programs.
While program participation is measured, VA does not adequately measure timeliness and accuracy rates separately from claims that go through the traditional process. The current bookkeeping rules stipulate that BDD claims be tracked from the
date of discharge whereas traditional claims are tracked beginning from the date
a veteran files a claim. So, while VA and DoD state a key advantage of the BDD
program is that it takes less time for the veteran to receive benefits after discharge,
the accuracy of such a statement remains unclear. While a case can be made that

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the clock should not start ticking until the servicemember transitions from the service and attains veteran status with the necessary DD214 form in hand, the actual
work done by VA employees to complete the rating decision and place the disability
compensation benefit in the new veterans account is not accurately measured. At
least 60 days is spent by VA staff developing a claim before a servicemembers discharge but this is not included in its measures of timeliness for processing BDD
claims, even though claims development is included in VAs timeliness measures for
traditional disability claims. According to the aforementioned GAO Report, VA data
shows that it is not processing claims (including BDD claims) as quickly as expected. By the end of FY 2007, it was taking an average of 76 days to complete BDD
claims, even though VA has an informal goal of completing work on BDD claims
no later than 60 days after discharge. In contrast, VA was taking an average of 183
days to complete all claims, compared to a goal of 125 days.
While information detailing the timeliness of receipt of benefits after discharge is
useful, excluding the time spent on development of claims makes it difficult to identify and understand any challenges in this stage of the process. This, in turn, impacts VAs ability to identify problems in a timely fashion and develop viable solutions to address them. The GAO Report GAO08901 noted,
Personnel in 12 of the 14 BDD intake bases we reviewed indicated significant
challenges with various claims development activities. For example, personnel
on several bases told us they had a hard time scheduling exams, because
servicemembers were leaving the area so they could complete their service at
home, among other reasons. Also, servicemembers at several bases may have
to obtain more than one exam and therefore take more time to complete their
BDD claim. Challenges such as these may delay the development of
servicemembers claims, putting them at risk of having to drop out of the BDD
program. Unless VA tracks performance related to claims development prior to
discharge, it cannot easily identify problems and compare performance across
BDD locations.
The report also noted, VA calculates a national accuracy rate, based on the percentage of claims that were processed without any errors. However, VAs accuracy
reviews to date have focused on claims overall, and have not targeted specific types
of claims, such as BDD. VA officials stated that the current sample approach and
size are sufficient for estimating a national accuracy rate, but are not sufficient for
obtaining precise results for specific types of claims. Consequently, VA is unaware
of the extent to which BDD claims are more or less accurately processed relative
to other claims and has incomplete information to help identify problems or challenges that BDD locations may face related to accurately developing claims.
As mentioned earlier, the servicemember applying for VA benefits through BDD
or Quick Start must provide either the original or a copy of their paper service
treatment records. This burden will be overcome for them and every other servicemember applying under other programs once the Veterans Lifetime Electronic
Record is established.
Another important step would be the implementation of a single comprehensive
medical examination as a prerequisite to completing the military separation process.
If and when a single separation physical becomes the standard, VA should have this
responsibility because it has the expertise to conduct a comprehensive examination
as part of its compensation and pension process.
The problem with separation physicals identified for active duty servicemembers
is compounded when mobilized Reserve and Guard forces enter the mix. A mandatory separation physical is not required for demobilizing Reserve and Guard members. Unfortunately, there have been some cases when they were not made aware
of this option, which later negatively impacted their ability to obtain a favorable
service connection. While separation physical examinations of demobilizing personnel have greatly improved, there are still a number of servicemembers who opt
out of the physicals, even when encouraged by medical personnel to have them.
While the expense and manpower needed to facilitate these physical exams might
be significant, the separation physical is critical to the future care of demobilizing
servicemembers. Mandatory separation physical examinations would also enhance
collaboration by the DoD and VA to identify, collect, and maintain the specific data
needed by each to recognize, treat, and prevent illnesses and injuries resulting from
military service.
The DoD and VA have made positive strides in transitioning our nations military
to civilian lives and jobs. The Department of Labors (DOL) Transition Assistance
Program (TAP) and Disabled Transition Assistance Program (DTAP), which are
handled by the Veterans Employment and Training Service (VETS) are typically the
first point of contact with the VA and DOL for a separating servicemember. Thanks

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to the insistence of the DoD, local commanders are allowing more of their soldiers,
sailors, airmen, marines, and coastguardsmen to attend these courses well enough
in advance to take advantage of the information they receive.
The TAP and DTAP programs have continued to improve, but challenges remain
at some local military installations, overseas locations and with services and information for those with injuries. The prospect of a servicemember after having been
on multiple deployments to return stateside and then be placed on medical or administrative hold has persuaded some from filing a claim for VA compensation or
other ancillary benefits. Also, though individuals are receiving the information, the
haphazard nature and quick processing time may allow some individuals to fall
through the cracks. This is of particular concern in the DTAP program where those
with severe disabilities may already be getting health care and rehabilitation from
a VA spinal cord injury center despite still being on active duty. Because these individuals are no longer located on or near a military installation, they are often forgotten in the transition assistance process. DTAP has not had the same level of success as TAP, and it is critical that coordination be closer between the DoD, VA, and
VETS to improve this disparity.
Many veterans with significant disabilities are turning to state vocational rehabilitation and workforce development systems because of these and other impediments to accessing VAs vocational rehabilitation and employment benefits. Almost
all state vocational rehabilitation agencies have entered into memoranda of understanding with VA to serve veterans. Disabled Veterans Outreach Program and Local
Veterans Employment Representative Program personnel are often housed in state
One-Stop Career Centers and these positions are often praised as a model that
should be emulated by the broader workforce system. However, all of these vocational programs are under considerable resource distress and their ability to serve
veterans who are unserved by the Vocational Rehabilitation and Employment Service is hindered by their own personnel and budgetary limitations.
Although the achievements of the DoD and VA have been good with departing active duty servicemembers, there is a much greater concern with the large numbers
of Reserve and National Guard servicemembers moving through the discharge system. Both the DoD and VA seem ill-prepared to handle the large numbers and prolonged activation of reserve forces for the global war on terrorism. The greatest
challenge with these servicemembers is their rapid transition from active duty to
civilian life. If servicemembers are uninjured, they may clear the demobilization station in a few days, and little of this time is dedicated to informing them about veterans benefits and services. Additionally, DoD personnel at these sites are most focused on processing soldiers through the site. Lack of space and facilities often restricts contact between demobilizing soldiers and VA representatives.
The DoD and VA have made progress in the transition process. Unfortunately,
limited funding and a focus on current military operations interfere with providing
for servicemembers who have chosen to leave military service. If we are to ensure
that the mistakes of the first Gulf War are not repeated during this extended global
war on terrorism, it is imperative that a truly seamless transition be created. With
this, it is imperative that proper funding levels be provided to VA and the other
agencies providing services for the vast increase in new veterans from the National
Guard and Reserves. Servicemembers exiting military service should be afforded
easy access to health care and other benefits that they have earned. This can only
be accomplished by ensuring that the DoD and VA improve their coordination and
information sharing to provide a seamless transition.
A review of the VA/DoD Joint Executive Councils Strategic Plan for FY 2009 to
2011 addresses the issue of seamless transition in Goal 3, Seamless Coordination
of Benefits. Their goal is to enhance collaboration efforts to streamline benefits application processes, eliminate duplicative requirements, and correct other business
practices that complicate the transition from active duty to veterans status. Their
objective is to improve participation in the BDD program nationwide and ensure
servicemembers are afforded the single cooperative examinations where available.
To achieve this goal, the Benefits Executive Councils Benefits Delivery at Discharge
Working Group is to align BDD with concurrent efforts dedicated to streamlining
delivery of VA benefits for eligible personnel; calculate and analyze BDD participation rates at MOU sites; and instill ownership of BDD with operational commanders. While strategic goals and objectives are important, they achieve the best
results when there are measureable outcomes with clear due dates. A review of this
objective finds neither. So, this successful program may lack the clarity of data from
the DoD as well, which may delay even greater utilization of this important and effective program.
It is the recommendation of the DAV that:

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1. DoD and VA ensure that servicemembers have a seamless transition from
military to civilian life.
2. DoD and VA continue to develop electronic medical records that are interoperable and bidirectional, allowing for a two-way electronic exchange of
health information and occupational and environmental exposure data.
These electronic medical records should also include an easily transferable
electronic DD214.
3. In accordance with the recommendation of the FY 2008 National Defense
Authorization Act and the recommendation of the Presidents Commission,
the DoD and VA implement a single comprehensive medical examination as
a prerequisite of promptly completing the military separation process. VA
should be responsible for handling this duty.
4. DoD and VA encourage active duty servicemembers to seek veterans service
organization representation during outprocessing and discharge examinations.
5. Congress and the Administration provide adequate funding to support TAP
and DTAP which are managed by the DOL Veterans Employment and
Training Service to ensure that active duty, as well as National Guard and
Reserve, servicemembers do not fall through the cracks while transitioning.
6. VA track and account for the time needed for claims development activities
that occur prior to discharge in the agencys timeliness calculation for BDD
and pre-discharge claims;
7. VA separately estimate the accuracy of BDD and predischarge claims;
8. VA collect data for all claims filed by Service component and analyze the
extent to which different components are filing claims and receiving timely
benefits under BDD, Quick Start, predischarge and traditional claims processes;
9. VA include program reviews of BDD operations as part of oversight visits
to regional offices with BDD operations and ensure such reviews are consistently conducted and reported;
10. DoD establish an accurate measure of servicemembers participation in TAP
including VA benefit briefings; and
11. DoD establish a plan with specific time frames for meeting its goal of 85
percent participation rate in TAP.
Mr. Chairman, this concludes my testimony. I will be pleased to answer any questions you or the Committee may have.
f

ccoleman on DSK8P6SHH1PROD with HEARING

Prepared Statement of Diana Rubens, Associate Deputy Under Secretary


for Field Operations, Veterans Benefits Administration, U.S. Department
of Veterans Affairs
Mr. Chairman and Members of the Subcommittee, it is my pleasure to be here
today to discuss our ongoing nationwide Benefits Delivery at Discharge (BDD) and
Quick Start pre-discharge programs. Joining me today is Bradley Mayes, Director
of the Department of Veterans Affairs (VA) Compensation & Pension (C&P) Service.
The BDD and Quick Start programs are two elements of the Veterans Benefits
Administrations (VBA) strategy to provide transitional assistance to separating or
retiring servicemembers and engage servicemembers in the claims process prior to
discharge. A pre-discharge claim is any claim received from a servicemember prior
to release from active duty. VBAs goal is to ensure that each and every servicemember separating or retiring from active duty who wishes to file a claim with VA for
service-connected disability benefits will receive assistance in doing so.
Participation in the BDD program is open to servicemembers who are within 60
to 180 days of being released from active duty and who are able to report for a VA
examination prior to discharge. However, for those servicemembers with 59 days or
less before separation, VA introduced the Quick Start pre-discharge claims process
in July 2008. This provides servicemembers within 59 days of separation, or
servicemembers within 60180 days of separation who are unable to complete all
required examinations prior to leaving the point of separation, to be assisted in filing their disability claim.
The BDD and Quick Start pre-discharge programs offer advantages to Veterans.
Minimal development is required because service records are readily available and
examinations are requested prior to discharge. Once service treatment records are
obtained, the servicemember acknowledges that notification required by the Veterans Claims Assistance Act of 2000 has been provided and is offered the opportunity to acknowledge that no additional medical evidence needs to be submitted.

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After the VA examination is conducted, the claim can be rated in a timely manner.
This process has generated a very high participation rate among servicemembers because disability benefits are received shortly after separation from service. During
fiscal year (FY) 2009, BDD and Quick Start claims represented just over 20 percent
of all original compensation claims received nationwide. However, during this same
period, approximately 65 percent of separating servicemembers who filed their
claims within one year of their discharge did so through the BDD and Quick Start
programs.
The average processing time, or average days to complete (ADC), for BDD and
Quick Start claims continues to show gradual improvement. At the end of FY 2009,
ADC for BDD claims was 70.8 days. At the end of FY 2009, ADC for Quick Start
claims was 105.9. ADC for both programs remains significantly lower than the nationwide ADC (160.7 days at the end of FY 2009) for all disability rating claims received.
Background
VBA established the BDD program at three VA regional offices and three Army
installations in 1995, and nationwide expansion began in 1998. Expansion promoted
the development of claims and the conduct of physical examinations sufficient for
VA rating purposes prior to separation with a disability rating to be completed as
closely proximate as possible to separation from active duty.
As the program gained momentum, the Department of Defense (DoD) and VA
signed a national memorandum of agreement in 2004 to establish the specific responsibilities of each department. At the same time, a team of VBA leaders from
central office, area offices, and regional offices (ROs) developed a proposal in November 2004 for consolidation of BDD claims processing. This provided an opportunity
to improve consistency in the way BDD claims are received and processed. It also
allowed VBA to reach a greater number of servicemembers as well as improve the
quality and accuracy of rating decisions. The Winston-Salem and Salt Lake City
ROs were selected as consolidated processing locations. BDD claims from the Eastern and Southern Areas were consolidated to Winston-Salem, while the BDD claims
from the Central and Western Areas were transferred to Salt Lake City. This consolidation was completed in April 2007.
BDD claims processing was further streamlined by incorporating imaging technology to enable paperless processing of these claims. Paperless BDD claims processing began as a pilot at the Winston-Salem Rating Activity Site (RAS) in March
2006 and was expanded to the Salt Lake City RAS in March 2007. The goal was
to paperlessly process BDD claims through their entire life cycle, from initial submission through adjudication and if applicable, appeal resolution. The advantages
to processing BDD claims in a paperless environment included the reduction of time
and costs associated with shipment of claims folders. In August 2008, all BDD
claims were sent to our scanning vendor for paperless claims processing at the two
RAS, and the expansion of BDD paperless claims processing was complete.
Consolidation of pre-discharge claims continued with the consolidation of Quick
Start claims to the San Diego RO and Winston-Salem RO in 2009. The San Diego
RO handles claims filed within VAs central and western areas and also those filed
from military installations in Korea. The Winston-Salem RO handles claims filed
within VAs eastern and southern areas and also those filed from military installations in Germany.
Current Technology Environment
Currently, all BDD claims are sent to VBAs scanning vendor, Hands On Ventures
Services. All information located within a BDD claims folder is scanned and
uploaded into Virtual VA. Virtual VA is the current image repository and provides
image capture, storage, and retrieval. The existing Virtual VA architecture and configuration are not a scalable solution for all C&P processing or VBA. The Veterans
Benefits Management System (VBMS) initiative is a large-scale effort to develop an
IT solution that is built on a scalable, agile architecture. Coupled with VBAs business transformation strategy, the VBMS initiative will enable our organization to
reach its goal of a benefits delivery model that provides world-class service to our
nations Veterans.

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Staffing
VBA currently has 143 employees dedicated to processing BDD claims at the Winston-Salem and Salt Lake City RAS, and 129 employees at Winston-Salem and San
Diego dedicated to processing Quick Start claims. Additional management and ad-

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ministrative staff are assigned to support BDD and Quick Start claims processing.
These employees are dedicated and provide excellent service to participants in both
programs.
Outreach Efforts
To ensure that servicemembers are aware of both the BDD and Quick Start programs, VA developed several outreach initiatives. Brochures describing the BDD
and Quick Start processes are distributed to servicemembers approaching separation. They are provided to all military installations involved with the programs and
are handed out to servicemembers during pre-discharge workshops describing VA
benefits. In addition, a Web page on VAs Internet site describes the pre-discharge
programs and explains all requirements. To simplify the actual claims process, BDD
and Quick Start claimants can now apply online. These outreach initiatives increase
servicemembers access to VA benefits and improve claims processing timeliness.
In addition to the BDD and Quick Start programs, VA continues to collaborate
with DoD in the seamless transition initiative, promoting a smooth and efficient
transition for individuals separating from the military. This includes National
Guard and Reserve members who are demobilizing from overseas deployment and
returning to their home units. VBA and the Veterans Health Administration conduct joint briefing sessions at military bases designed to provide information on the
entire range of VA benefits and health care services.
One formal pre-discharge outreach program conducted by VA and the Departments of Defense and Labor is the Transition Assistance Program (TAP). During
TAP briefings, VBA personnel explain the disability compensation process and provide assistance to servicemembers interested in filing a claim. The Disabled Transition Assistance Program (DTAP) is specifically designed to assist servicemembers
facing separation because of disability incurred during service. In addition to TAP
and DTAP briefings, VA conducts informational sessions for demobilized National
Guard and Reserve members at the units community location.
Another major seamless transition project resulting from DoD and VA collaboration is the Disability Evaluation System (DES) for the 27,000 servicemembers who
enter the medical evaluation board process on an annual basis. The goals are to improve consistency of outcomes, establish an increased sense of equity by DES participants, increase transparency, reduce the time servicemembers are in the process,
and ease their transition to civilian life. This joint effort reduced the time from separation to receipt of initial VA disability payment to an average of 25 days. By end
of March 2010, the pilot will be at 27 installations, accounting for 46 percent of all
DES participants. Plans are underway for full deployment of the pilot process, pending authorization of the VA/DoD Senior Oversight Committee.
Conclusion
VBA is committed to providing efficient and timely service to our nations Veterans. We will continue to evaluate the BDD and Quick Start programs to identify
improvements that can be accomplished with the current technology platform and
to capture requirements for new technology capabilities to further enhance benefits
delivery under these important programs and improve Veterans experience. This
concludes my testimony. I would be pleased to address any questions you may have.
f
Statement of American Federation of Government Employees,
AFLCIO and AFGE National Veterans Affairs Council
Thank you for the opportunity to present the views of members of the American
Federation of Government Employees (AFGE) and the AFGE National Veterans Affairs Council (AFGE NVAC) who process claims under the Benefits Delivery at Discharge (BDD) and Quick Start Programs.

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Recommendation: Eliminate Redundancy


One of the most significant problems plaguing the BDD and Quick Start Program
is the redundancy created by two separate programs that essentially perform the
same task. The only real difference between the two programs is application deadlines, i.e. between 60 and 180 days prior to separation for BDD, and 60 days or less
for Quick Start.
The operation of two similar program results in the unnecessary duplication of resources, including supervisory and support personnel. This arrangement also creates

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inequities: Since the Quick Start team works exclusively on claims filed within 60
days prior to separation; they are necessarily completing more recent claims than
those being processed in BDD.
It would be more efficient and equitable to place both programs under the BDD
umbrella and eliminate the arbitrary restriction that BDD claims cannot be filed
within 60 days prior to separation. In addition, all claims processed from active military service under the pre-discharge processes should be processed via a Paperless
Claims Processing System. As the VA is transitioning into the paperless environment, to continue processing claims outside of the paperless system, as Quick Start
does, will only result in further delays in the transition.
Recommendation: Improve Training
Our VBA members express great frustration at the lack of adequate training generally, and specifically for these programs. Current training requirements for VBA
employees processing BDD and Quick Start claims is minimal, consisting exclusively
of emails that list references to review. Employees are denied the opportunity for
interaction or discussion about many of the complicated tasks required to process
these pre-discharge claims.
Recommendation: Stop consolidation of paperless pre-discharge claims
With regard to claims handled through Supplemental Paperless Claims Processing, AFGE and AFGE NVAC recommend that all claims be maintained in the
VARO of jurisdiction. Consolidation of paperless pre-discharge claims to centralized
locations is a disservice to veterans, especially since the paperless claims processing
system is now available for use by all offices. Consolidation results in unnecessary
delays in processing when the need for additional development or examinations
arises, and the claim is no longer located in the state where the veteran resides.
The current practice of isolating paperless claims (following the initial rating action) at the VARO Winston Salem and VARO Salt Lake also results in unnecessary
delays in filing supplemental claims. Veterans who participate in the Quick Start
program have their claims forwarded to the VARO of jurisdiction. Veterans should
not be treated differently due to the time in which they filed their claim during separation.
Recommendation: Increase the quality and consistency of C&P Exams
The poor quality of many C&P exams, and thus, the need for re-examination, results in further processing delays. These exam deficiencies particularly impact predischarge claims.

ccoleman on DSK8P6SHH1PROD with HEARING

Recommendation: Improve tracking of pre-discharge claims


Currently, BDD and Quick Start claims are only tracked after discharge, when
most of the development is already complete. AFGE and AFGE NVAC concur with
GAOs recommendation to track BDD and Quick Start claims during the development process. Tracking during claims development would enable VBA to identify
areas of deficiencies.
For example, a common problem with pre-discharge cases is the difficulty of obtaining service treatment records (STRs). The current practice of requesting a copy
of the veterans STR at his or her DTAP briefing works well for those who are part
of the regular armed forces. However, some of these veterans have prior periods of
service; before the case can be rated, VBA must obtain the STRs for all periods of
service. This results in additional delay because VBA must then request STRs from
the National Personnel Records Center or Records Management Center.
Tracking during the development process would enable VBA to spot deficiencies,
such as how many veterans have prior periods of service and the timeliness delays
that are caused by not requesting all STRs up front.
Another problem concerning STRs involves veterans from the National Guard or
Reserve. They are not required to submit STRs with their application and the obligation falls on VBA to obtain the STRs from the state adjutant general or from the
reserve unit. This often causes delays in the claims process because the employee
frequently has to send multiple requests to get these records. Often times records
for these veterans are never received.

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Therefore, VBA should be tracking how many cases are submitted by National
Guard and Reservists and the amount of time required to obtain their STRs, as well
as how often the STR is unavailable. Tracking would also enable VBA to identify
improper denials resulting from missing STRs.
Thank you.

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MATERIAL SUBMITTED FOR THE RECORD
Committee on Veterans Affairs
Subcommittee on Disability Assistance and Memorial Affairs
Washington, DC.
March 25, 2010
Daniel Bertoni
Director, Education, Workforce, and Income Security Issues
U.S. Government Accountability Office
441 G Street, NW
Washington, DC 20548
Dear Mr. Bertoni:
Thank you for testifying at the House Committee on Veterans Affairs Subcommittee on Disability Assistance and Memorial Affairs oversight hearing on the
Examination of the Benefits Delivery at Discharge and Quick Start Programs,
held on February 24, 2010. I would greatly appreciate if you would provide answers
to the enclosed follow-up hearing questions by Monday, April 26, 2010.
In an effort to reduce printing costs, the Committee on Veterans Affairs, in cooperation with the Joint Committee on Printing, is implementing some formatting
changes for material for all full Committee and subcommittee hearings. Therefore,
it would be appreciated if you could provide your answers consecutively on letter
size paper, single-spaced. In addition, please restate the question in its entirety before the answer.
Due to the delay in receiving mail, please provide your responses to Ms. Megan
Williams by fax at (202) 2252034. If you have any questions, please call (202) 225
3608.
Sincerely,
John J. Hall
Chairman

U.S. Government Accountability


Washington, DC.
April 16, 2010
The Honorable John J. Hall
Chairman
Subcommittee on Disability and Memorial Affairs
Committee on Veterans Affairs
House of Representatives

ccoleman on DSK8P6SHH1PROD with HEARING

Subject: Responses to Questions for the RecordHearing Entitled Examination of


the Benefits Delivery at Discharge and Quick Start Programs
Dear Mr. Chairman:
This letter responds to your March 25, 2010 request that we address questions
for the record related to the Subcommittees February 24, 2010 hearing examining
the Benefits Delivery at Discharge and Quick Start Programs. Our responses to the
questions, which are in the enclosure, are based on our previous work and knowledge of the subjects raised by the questions.
If you have any questions about the letter or need additional information, please
contact me at (202) 5127215 or bertonid@gao.gov.
Sincerely yours,
Daniel Bertoni
Director, Education, Workforce, and Income Security Issues
Enclosure

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Response to Questions from the House Committee on Veterans Affairs
Subcommittee on Disability Assistance and Memorial Affairs
Oversight Hearing the Examination of Benefits Delivery at Discharge and
Quick Start Programs
February 24, 2010

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1. In your testimony, you recommended that DoD expand mandatory


Transition Assistance Program (TAP) briefings beyond the Marine
Corps to all military service branches.
In our 2008 report, we recommended that to ensure that potentially eligible participants are aware of the BDD program, DoD should establish a plan with specific
time frames for meeting its goal of 85 percent participation in TAP. Increased participation in the VA benefits session in TAP may allow more members to self-identify their eligibility for these programs. Although DoD reported to us in September
2009 that it is preparing to develop a plan and specific time frames in the coming
months, the longer the agencies lack a plan or a way to accurately measure progress
toward meeting the TAP participation goal, the less information they will have on
the extent to which VA benefits briefings are reaching all transitioning
servicemembers may benefit from VAs pre-discharge programs.
In your opinion, what are the pros and cons of this proposed expansion
of TAP?
In our 2008 report 1, we note that according to DoD and VA personnel,
servicemembers most commonly learn about the program through VA benefits briefings conducted as part of TAP sessions. We found that without such briefings, some
members may not recognize they are entitled to receive VA benefits, and may file
claims through BDD or Quick Start programs. However, because briefings are not
mandatory for all service branches, whether commanders and supervisors encourage
servicemembers to attend briefings varies by base. Moreover, some DoD officials told
us that servicemembers may not recognize the importance of the VA benefits briefings if participation is not required, because members have a host of discharge requirements and limited time to complete them.
While VA and DoD have explored the expansion of TAP, they have not made participation in TAP sessions mandatory for servicemembers. We reported in a 2005
report 2 that command supervisors may feel that mission needs are too pressing to
allow some servicemembers to participate in TAP. In addition, DoD officials have
indicated that because TAP sessions involve components from three federal agenciesDoD, VA, and DOLthe coordination of a mandated program could be challenging.
Could VAs disability claims process be improved by establishing the
BDD or Quick Start programs as automatic components of the discharge
process for all servicemembers, whether they are claiming a service connected disability or not?
Filing a VA disability claim through the BDD program can be faster than filing
a claim as a veteran under the traditional claim process, because medical records
are more readily accessible and key forms needed to process the claim can be signed
immediately. Moreover, establishing that the claim is related to the members military service may be easier, since the member is still on active duty status. On the
other hand, expanding the number of claims processed through the BDD and Quick
Start programs to include all servicemembers who are discharged regardless of
whether they have a service connected disability will likely result in processing ineligible claims, which in turn may negate some of the programs efficiencies. Any
decrease in the overall speed of claims processing may result in less timely receipt
of VA disability compensation for all servicemembers participating in the programs.
This is especially true since, over the last several years, VA has experienced an increase in disability compensation claims, which in turn has contributed to a growing
number of pending claims.
2. A Veteran Service Organization (VSO) representative testified that
the BDD and Quick Start programs could be improved by allowing
servicemembers to start the pre-discharge process earlier, perhaps
1 GAO, Veterans Disability Benefits: Better Accountability and Access Would Improve the Benefits Delivery at Discharge Program, GAO08901 (Washington, D.C.: Sept. 9, 2008).
2 GAO, Military and Veterans Benefits: Enhanced Services Could Improve Transition Assistance for Reserves and National Guard, GAO05544 (Washington, D.C.: May 20, 2005).

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54
as early as six months before discharge. What impact would such a
move have on further improving the BDD and Quick Start programs? Do you think that an earlier start date for the pre-discharge
process might permit disabled veterans to begin receiving benefit
compensation within a month after discharge rather than 180 days
after discharge, on average, as is the case now?
Under the BDD programs current structure, servicemembers may initiate a claim
as early as 180 days (6 months) prior to discharge or as late as 60 days (2 months)
prior to discharge. According to VA, these times frames allow for sufficient time
prior to discharge for local VA personnel at BDD intake sites located on or near the
base to assist members with their disability applications, including scheduling their
exam(s). While a claim may be developed prior to discharge, VA cannot authorize
the award until the member is discharged. To the extent that 180 days provides sufficient time to process BDD claims and VA is legislatively restricted regarding when
it can authorize and award payments until discharge, it is unclear how allowing a
member to file a claim earlier than the 180 days currently allowed would improve
the BDD program or expedite receipt of benefits.
Quick Start claims are available for servicememberssuch as National Guard
and Reservistswho are not able to meet BDD program requirements, such as remaining on base long enough to complete exams within the 60180 day time window. Unlike BDD claims, Quick Start claims generally require additional development after discharge, which can delay award decisions and receipt of payment. Our
prior work did not explore the feasibility or efficacy of initiating the process earlier
for servicememberssuch as National Guard and Reservistswho, because they are
deactivated quickly after returning to their home base, generally have difficulty
meeting BDD program requirements.
3. In your testimony, you note that most VA and DoD Memos of Understanding (MOU) require a VA physician to administer the joint physical exam required by the BDD and Quick Start programs. As a result, you observe that many servicemembers stationed on bases with
no access to VA physicians cannot secure the joint exam needed for
the BDD program. How should this problem be fixed, and what can
Congress do to assist the resolution of this issue?
Most VA and DoD BDD MOUs require a VA physician to administer the joint
physical exam offered under the BDD program. However, a physical exam prior to
discharge is not a requirement for participation in the Quick Start program. In our
2008 report, we recommended that to ensure that servicemembers have full access
to a cooperative exam process that is convenient, efficient, and consistent for
servicemembers, the Chairs of the Joint Executive Council should direct the Benefits Executive Council to identify and disseminate information on promising practices that address challenges local officials commonly face. VA and DoD have taken
some steps to implement this recommendation, including collaborating to identify
best practices for dealing with the cooperative exam process as it relates to the challenges local personnel commonly face.
In addition, DoD and VA are piloting a joint disability evaluation process involving a single physical exam for servicemembers who may need to be discharged due
to a disabling condition. The pilot is currently taking place at 27 military facilities,
many of which are also BDD facilities, and DoD and VA are considering whether
to expand the pilot DoD-wide. The pilot may present an additional opportunity to
improve collaboration and communication between DoD and VA. However, it could
also present challenges, for example, by increasing local VA offices exam caseloads.
GAO has a review underway of the disability evaluation system pilot.
4. Your testimony noted that VA consolidated the claims processing operations for the BDD program into two VA Regional Offices (ROs),
in Winston-Salem, NC and Salt Lake City, UT. Quick Start claims are
also processed in two locations, the Winston-Salem RO and the San
Diego RO. One VSO representative recommended that the processing
of these claims could be expedited by permitting all ROs to process
BDD and Quick Start claims. Do you agree with this recommendation, or do you recommend another approach?
In our 2008 report, we noted that in 2006 VA completed its effort to consolidate
rating activities for BDD claims in two regional officesSalt Lake City, Utah, and
Winston-Salem, North Carolinain order to improve the consistency and timeliness
of BDD ratings. We noted that VA had not evaluated whether consistency or timeliness had improved compared to prior practices, although VA officials told us they

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monitored claims workloads between the rating offices and in one case sent claims
from one office to the other so claims could be processed more quickly. Since our
report, in August 2009, VA consolidated the processing of Quick Start claims to two
locations, Winston-Salem, North Carolina and San Diego, California. Consistent
with our prior recommendation related to another initiative 3, before VA considers
making changes to its Quick Start processes, such as adding additional rating sites,
it would be prudent for VA to evaluate the impact of consolidation on timeliness as
well as on consistency of Quick Start claims processing.
5. In 2009, a reported 65 percent of separating servicemembers who
filed a claim within one year of their discharge did so through one
of these programs. Is this an acceptable level of participation? If not,
what should be the proper target?
For several years, VA has had a strategic target that 65 percent of separating
servicemembers who filed a claim within one year of discharge would file through
the BDD program. According to VA, while the agency has yet to reach that goal,
it is striving to do so by 2011. VA recently modified the measurement of BDD participation by including only those members who discharge from BDD locations (in
the past, it had included members discharging from any location, including those
that did not accept BDD claims). This change reduces the number of
servicemembers counted in the denominator without changing the numerator, and
therefore makes VAs target of 65 percent easier to reach.
Beyond this change, VA may also have begun to include claims filed under the
Quick Start program in the BDD participation rate numerator. In its 2009 Performance and Accountability Report, VA reported that the BDD participation rate now
includes those whose date of claim is before discharge, which presumably would
include servicemembers who use the Quick Start program. Because Quick Start
claims can be filed from any location, this adjustment could result in some
servicemembers being counted in the numerator (for filing Quick Start Claims) and
not in the denominator (for filing from non-BDD locations). Further, if the BDD participation rate does include Quick Start claims, then it may make sense to have a
target that is higher than 65 percent participation, since the current target was set
before Quick Start existed.
In our prior work, we were unable to obtain data from DoD on the number of
servicemembers discharged from BDD versus non-BDD locations and therefore did
not assess the appropriateness of the adjusted 65 percent target. Regardless of the
target rate, we continue to believe thatbecause servicemembers generally learn
about BDD through TAPit is important that VA and DoD make progress toward
developing a plan and an accurate measure for achieving their TAP participation
goal.

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f
Committee on Veterans Affairs
Subcommittee on Disability Assistance and Memorial Affairs
Washington, DC.
March 25, 2010
The Honorable Noel Koch
Deputy Under Secretary of Defense
Office of Wounded Warrior Care and Transition Policy
U.S. Department of Defense
1400 Defense Pentagon
Washington, DC 20301
Dear Mr. Koch:
Thank you for testifying at the House Committee on Veterans Affairs Subcommittee on Disability Assistance and Memorial Affairs oversight hearing on the
Examination of the Benefits Delivery at Discharge and Quick Start Programs,
held on February 24, 2010. I would greatly appreciate if you would provide answers
to the enclosed follow-up hearing questions by Monday, April 26, 2010.
In an effort to reduce printing costs, the Committee on Veterans Affairs, in cooperation with the Joint Committee on Printing, is implementing some formatting
changes for material for all full Committee and subcommittee hearings. Therefore,
it would be appreciated if you could provide your answers consecutively on letter
3 In our 2008 report, we recommended that VA conduct an evaluation of the paperless claims
processing initiative to determine which adjustments, if any, are needed to improve implementation of the program.

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size paper, single-spaced. In addition, please restate the question in its entirety before the answer.
Due to the delay in receiving mail, please provide your responses to Ms. Megan
Williams by fax at (202) 2252034. If you have any questions, please call (202) 225
3608.
Sincerely,
John J. Hall
Chairman

Questions From the House Committee on Veterans Affairs


Subcommittee on Disability Assistance and Memorial Affairs
Oversight Hearing the Examination of the Benefits Delivery at Discharge
and Quick Start Programs
February 24, 2010
Question 1: Your testimony pointed out that servicemembers learn of the BDD
and Quick Start programs during Transition Assistance Program (TAP) briefings.
However, a 2008 report issued by the U.S. Government Accountability Office (GAO)
entitled Veterans Disability Benefits: Better Accountability and Access Would Improve the Benefits Delivery at Discharge Program, revealed that only the Marines
have made these briefings mandatory. The Subcommittee has learned that while
Department of Defense (DoD) policy requires commanders to allow servicemembers
to attend TAP sessions upon the members request, in some cases servicemembers
have not been released from their duties to attend the briefings. Why arent TAP
briefings mandatory for all branches, and what additional resources, if any, does
DoD need to make TAP briefings mandatory for all of the service branches?
Answer: The Department would have to defer to the Departments of Labor and
Veterans Affairs regarding modifying mandatory servicemember participation in
TAP. DoD does not have the authority to make those sessions mandatory.
The Joint Executive Committee (JEC) requested the TAP Steering Committee, an
inter-agency body (representatives from Departments of Defense, Labor, Veterans
Affairs, Homeland Security, the Military Departments, and the Office of Personnel
Management) responsible for monitoring all aspects of TAP, to develop a plan for
mandatory TAP briefings. This plan will be presented at the June JEC meeting.
Question 2: At what point does the pre-discharge process begin once a servicemember approaches the date of their discharge? Are servicemembers transferred out
of theatre to have their physicals, get TAP briefings, and complete other decommissioning procedures?
Answer: Servicemembers can file a BDD claim no more than 180-days but not
less than 60 days prior to separation, retirement, or in the case of a National
Guardsman/Reservist, release from active duty. It is VA policy that the Servicemember filing under BDD must: (1) have a known separation date; (2) complete a single
joint examination; (3) turn in a complete copy of their medical record at the time
they submit their BDD claim.
Quick Start program claims can be filed no more than 59-days before but not less
than 1 day prior to separation, retirement, or in the case of a National Guardsman/
Reservist, release from active duty. The same requirements for BDD are applicable
to Quick Start claims.
In regard to location, no, DoD does not transfer servicemembers out of theater to
complete physical exams, get TAP briefings, or complete other decommissioning requirements.
These pre-discharge program requirements were established by the Department
of Veterans Affairs.

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Question 3: A veteran service organization (VSO) representative testified that


the BDD and Quick Start programs could be improved by allowing servicemembers
to start the pre-discharge process earlier, perhaps as early as 6 months before discharge. What are the pros and cons of starting the pre-discharge process earlier in
DoDs opinion?
Answer: The following pros and cons reflect the opinions, not DoD policy.
Pros of starting the pre-discharge process earlier:

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1. Servicemembers would have more time to assimilate the enormous volume
of information on the benefits, services, and resources they may be entitled
to receive.
2. A higher percentage of servicemembers re-enlist the earlier they start the
transition process compared to those starting the transition process much
later (findings from an Informal Navy survey conducted in the 1990s).
3. Allows servicemembers to submit applications for VA compensation claims in
a timely manner before separating or retiring.
4. Servicemembers would have more time to compare and weigh their options
for staying in the military vs. actually separating or retiring.
5. Stressors normally associated with the entire transition process and experience may be reduced if servicemembers start the process earlier.
6. More spouses may become actively involved in the transition process if the
servicemember began the pre-discharge process earlier.
7. Professional staffs should be able to manage clients better, devote more time
to those who need the most attention, and provide more individualized assistance in counseling and coaching servicemembers.
Cons of starting the pre-discharge process earlier:

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1. Will require the Services to increase resources. Servicemembers who begin


the process earlier tend to go back multiple times for individualized counseling/coaching, compared to the number of repeat visitors to transition offices when servicemembers have little time remaining on Active Duty. (This
may be problematic for operations)
2. Demobilizing National Guard and Reservists would begin the process in theatre. This would require additional facilities, equipment, personnel, etc. to be
permanently placed in theatre to assist in the early transition process.
3. Conducting pre-discharge counseling in theater may not be conducive for
Servicemembers receiving and assimilating the information and assistance.
4. For National Guard and Reservists, providing the transition process earlier
at home station would mean increasing the number of non-training days a
member would be called on Active Duty to receive the necessary counseling
and coaching. This could also be a problem for employers.
5. For deployed National Guard/Reservists, they would not be able to complete
the joint DoD/VA physical examination while in theater to take advantage
of an earlier submission date. For that reason, DoD would have to defer to
the Department of Veterans Affairs (VA) regarding changes in policy that
would allow earlier acceptance of pre-discharge claims and earlier administration of the joint DoD/VA physical examination under VAs program.
Question 4: In your opinion, are there other ways for improving the pre-discharge process to facilitate increased usage of the BDD and Quick Start program
for transitioning disabled servicemembers?
Answer: Yes, there are other ways to improve the pre-discharge process. The Department is undertaking several initiatives to improve usage of BDD and Quick
Start, for example Recovery Care Coordinators will be trained to inform
transitioning disabled Servicemembers who they need to contact for assistance in
applying for BDD/Quick Start. Also, we are modifying the pre-separation counseling
checklist for Active Duty and the transitioning checklist for the Reserve Components so BDD/Quick Start items will be addressed by transitioning counselors. Lastly, we have added the pre-discharge link to the official DoD TurboTAP Web site and
are doing strategic messaging on our social networking sites (i.e., Facebook and
Twitter) to encourage early participation where services are available.
Question 5: GAO noted in its testimony, that most VA and DoD Memos of Understanding (MOU) require a VA physician to administer the joint physical exam
required by the BDD and Quick Start programs. GAO thus observed that many
servicemembers stationed on bases with no access to VA physicians cannot secure
the joint exam needed for the BDD program. How should this problem be fixed, and
what can Congress do to assist the resolution of this issue?
Answer: If the military installation is not located near a Department of Veterans
Affairs (VA) hospital, VA can contract out the joint DoD/VA examination to meet
the required examination protocol. At those military locations where the necessary
resources are available (sufficient medical personnel/type of specialty equipment),
DoD providers can also be trained to conduct the joint DoD/VA examination. The
Department is closely monitoring these situations, and making the adjustments
when needed.

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The Department appreciates Congressional support, and we will continue to work
with Congress to provide legislative requests through the formal legislative request
channels.
Question 6: How many military bases are there, and what percentage of these
bases enables servicemembers to access joint DoD/VA exams?
Answer: The joint DoD/VA exam is provided at 131 military installations, which
is 16 percent of the 820 U.S. military installations.
Question 7: The Quick Start program was created to ensure that our soldiers
serving in active duty from Guard and Reserve units can also take advantage of the
benefits of the pre-discharge program. Are we offering Quick Start examinations at
Guard bases, such as the NY National Guards Camp Smith? If so, how many Guard
bases have the resources to perform these Quick Start exams? What resources do
you need to ensure that Quick Start exams can be offered at all bases that Guard
Members and Reservists return after their active duty service?
Answer: Yes, the Department offers examinations at 53 military installations
where demobilization/deactivation of National Guard and Reserves takes place and
there is a VA presence. NY National Guard Camp Smith is not currently one of
those installations.
The Department defers to VA on additional resources required for expanding the
Quick Start program as VA is the administrator of the program.
Question 8: How much time is needed, on average, to administer a joint DoD/
VA exam?
Answer: The Department of Veterans Affairs reports from October 1, 2009
through March 31, 2010, took an average of 33.2 days to administer the joint DoD/
VA exam.

Committee on Veterans Affairs


Subcommittee on Disability Assistance and Memorial Affairs
Washington, DC.
March 25, 2010

ccoleman on DSK8P6SHH1PROD with HEARING

Thomas Tarantino
Legislative Associate
Iraq and Afghanistan Veterans of America
292 Madison Avenue, 10th Floor
New York, NY 10017
Dear Mr. Tarantino:
Thank you for testifying at the House Committee on Veterans Affairs Subcommittee on Disability Assistance and Memorial Affairs oversight hearing on the
Examination of the Benefits Delivery at Discharge and Quick Start Programs,
held on February 24, 2010. I would greatly appreciate if you would provide answers
to the enclosed follow-up hearing questions by Monday, April 26, 2010.
In an effort to reduce printing costs, the Committee on Veterans Affairs, in cooperation with the Joint Committee on Printing, is implementing some formatting
changes for material for all full Committee and subcommittee hearings. Therefore,
it would be appreciated if you could provide your answers consecutively on letter
size paper, single-spaced. In addition, please restate the question in its entirety before the answer.
Due to the delay in receiving mail, please provide your responses to Ms. Megan
Williams by fax at (202) 2252034. If you have any questions, please call (202) 225
3608.
Sincerely,
John J. Hall
Chairman

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TO:
RE:

House Veterans Affairs Committee (DAMA)


Follow-Up Questions from IAVAs Testimony on February 24,
2010
PREPARED BY:
Tom Tarantino, Legislative Associate
1. How would it help VA if the Transition Assistance Program (TAP)
briefings and BDD or Quick Start exams were mandatory for all decommissioning servicemembers? Do you believe VA has the resources needed for this expansion?
Over the past year, VA has engaged in an ever-increasing effort to reach out to
veterans in hopes of enrolling them into the VA Heath Care system. Mandatory
TAP briefings would provide a captive audience to reach out to new veterans and
explain how the VA can be used as a resource. Most servicemembers do not have
a clear idea as to what the VA does, or what services it provides. Mandatory briefings at or near the point of discharge should be a key component to achieving a
seamless transition from DoD to VA Care. These briefings should be uniform across
all services and within a time frame that use of BDD and Quick Start programs
are feasible.
The VA has regional offices all over the Nation that cover every military base
where out-processing is conducted, yet, there is no established procedure for having
VA representatives liaising with DoD out-processing services. The VA should have
a team in every VISN whose sole function is to be a new veterans first contact with
the VA while processing out of the military. They should be experts in VA services
and have the ability to either enroll them into VA health care, or direct them to
a service officer for assistance with VBA claims. A new veteran shouldnt have to
search to find the benefits that they have earned.
2. What can Congress do to assist VA and DoD in expanding TAP briefings and BDD or Quick Start exams to all discharging
servicemembers?
Congress needs to enact legislation that requires TAP briefings for all exiting
servicemembers. While each service will have service specific components to the
briefing, the timeline and the VA benefits portion should be uniform and explicit
in statute. These briefings should be conducted by a VA expert and mandated in
such a time frame where utilization of BDD and Quick Start programs are both convenient and realistic.
3. The Memo of Understanding (MOU) between VA and DoD largely
permits only VA physicians to conduct single exams. Is this a problem and if so, should more training be provided to DoD physicians
so that they can conduct these exams more often?
While it would be ideal for expedience and convenience to have both DoD and VA
physicians conduct the exit physical evaluations, it isnt realistic. VA physicians are
the only ones consistently qualified to conduct Compensation and Pension examinations and apply the VA schedule of rating. As the ultimate disability rating is under
VA regulations, the examination should remain a VA function.
4. You testified that even when comprehensive physical exams are administered, there is not enough time or resources to complete them
effectively. What might Congress do to resolve this issue?
As mentioned in my answer to question 2, TAP briefings must be mandatory with
uniform benefits briefings. These briefings should be conducted within a time frame
where utilization of BDD is realistic and covenant. In these briefings
servicemembers should be able to begin the BDD or quick start process. This way,
all parties have sufficient time to conduct the exams and evaluate the results.
5. GAO reported that VA has established only one measure for gauging
the effectiveness of the BDD and Quick Start programs. However, it
seams that VA has several means for measuring general disability
claims. Do you agree additional quality measurements could assist
VA in fully implementing BDD?
Yes. However, the VA does not have a particularly good method for measuring
quality in any of its disability claims. With a 17 percent error rate in the regular

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claims process, its clear that this is an area that the VA must improve on as a
whole. The STAR program is largely a quality assurance method, which is procedural in nature and does very little to ensure that the decisions themselves were
correct. The VA needs to reassess its entire quality control program before extending the current broken evaluation system to BDD and Quick Start.
6. Some Veteran Service Organizations (VSOs) express frustration by
VAs lack of efforts in collaborating with them in increasing utilization of BDD and Quick Start programs. Please expand upon the challenges faces by your organization in this regard? What can Congress
do to increase the cooperation between VA and VSOs with respect
to the BDD and Quick Start Programs?
IAVA helps veterans by raising awareness, advocating for reforms and assisting
veterans and their families to find the best services available. However, we do not
provide traditional services and do not employ service officers. As such, we have not
seen too many organizational challenges in this regard. We do believe that VSO
Service Officers are invaluable resources for veterans navigating the VA system.
Service officers should be a component to TAP programs and be included in local
BDD and Quick Start Programs. Local service offices can act as a knowledgeable
interface between the veteran, the DoD and the VA during the process.
7. Are you aware of any unique challenges by members of the National
Guard and Reservists in gaining information about the Quick Start
program and filing claims through this program?
Members of the National Guard and Reserve components are being mobilized at
unprecedented rates. As a result, more members of the Select Reserve are eligible
for a wider range of VA benefits than ever before. Yet, members of the Select Reserve do not have the same access to information and benefits, as do their Active
Duty peers. To help bridge this gap IAVA recommends that VA offer training to selected AGR members of the National Guard and Reserve so that each unit has a
benefits and resources councilor organic to the unit.
f
Committee on Veterans Affairs
Subcommittee on Disability Assistance and Memorial Affairs
Washington, DC.
March 25, 2010

ccoleman on DSK8P6SHH1PROD with HEARING

Gerald T. Manar
Deputy Director of National Veterans Service
Veterans of Foreign Wars of the United States
200 Maryland Avenue, SE
Washington, DC 20002
Dear Mr. Manar:
Thank you for testifying at the House Committee on Veterans Affairs Subcommittee on Disability Assistance and Memorial Affairs oversight hearing on the
Examination of the Benefits Delivery at Discharge and Quick Start Programs,
held on February 24, 2010. I would greatly appreciate if you would provide answers
to the enclosed follow-up hearing questions by Monday, April 26, 2010.
In an effort to reduce printing costs, the Committee on Veterans Affairs, in cooperation with the Joint Committee on Printing, is implementing some formatting
changes for material for all full committee and subcommittee hearings. Therefore,
it would be appreciated if you could provide your answers consecutively on letter
size paper, single-spaced. In addition, please restate the question in its entirety before the answer.
Due to the delay in receiving mail, please provide your responses to Ms. Megan
Williams by fax at (202) 2252034. If you have any questions, please call (202) 225
3608.
Sincerely,
John J. Hall
Chairman

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Questions from the House Committee on Veterans Affairs
Subcommittee on Disability Assistance and Memorial Affairs
Oversight Hearing the Examination of the Benefits Delivery at Discharge
and Quick Start Programs
February 24, 2010

ccoleman on DSK8P6SHH1PROD with HEARING

This is in response to the questions submitted by the House Committee on Veterans Affairs in conjunction with the oversight hearing on the Examination of the
Benefits Delivery at Discharge and Quick Start Programs held on February 24,
2010.
1. How would it help VA if the Transition Assistance Program (TAP) briefings
and BDD or Quick Start exams were mandatory for all decommissioning
servicemembers? Do you believe VA has the resources needed for this expansion?
Response: How would it help VA is not, in our view, the appropriate question.
Rather, we believe that the question to ask is how would it help discharging
servicemembers if the TAP briefings were mandatory and BDD and Quick Start examinations required?
Clearly, making TAP briefings mandatory for all discharging servicemembers, including deactivating National Guard and Reserve personnel would impose an additional and substantial burden on VA. Although VBA has received substantial increases in FTE over the past few years, the focus has been on training them to develop, process and finalize pending claims. Outreach, while very important, only attracts more claims; it doesnt resolve any. Should Congress decide to make TAP
briefings mandatory, additional FTE would be required for both the outreach efforts
AND claims processing.
We do not believe that VBA currently has the resources to increase outreach nor
the staff to process the additional claims generated from outreach efforts. FTE provided by Congress in the last few years has been allocated to processing claims.
Claims receipts increased by 14 percent in FY 2009 and, reportedly, by another 10
percent FYTD. Clearly, they need to focus on the current work at this time.
However, VBA estimates that pending inventories will peak in FY 2012 and begin
to fall in the years that follow. Rather than decrease FTE as anticipated in FY 2014
and beyond, VBA could reallocate staff to improving outreach to departing
servicemembers. While this is not the ideal approach, it is, in our view, the most
practical.1
2. What can Congress do to assist VA and DoD in expanding TAP briefings and
BDD or Quick Start exams to all discharging servicemembers.
Response: There are several issues here:
What can Congress do to expand TAP briefings? The simplest thing is to pass
legislation requiring every discharging servicemember, including Guard and
reserve personnel, to participate in mandatory TAP briefings. These briefings
are designed to provide discharging servicemembers essential information on
a wide variety of subjects which help ease transition from active duty to civilian life.
Since VA does not, in our opinion, currently have the resources to provide
staff to conduct additional TAP briefings, it would be necessary to either plusup the Veterans Benefits Administration (VBA) FTE or utilize alternative
methods, such as computerized training modules or videoconferencing, to provide this information.
Should Congress require a discharge physical examination for all discharging
servicemembers? At one time discharging servicemembers were required to
undergo a complete physical examination at discharge. This examination provided a coda to military service by providing a snapshot at the point of discharge of the servicemembers physical and mental condition. It also complimented the entrance examination and provided VA with information that
documented changes, whether acute or chronic, new or old, at discharge. We
believe it is an extremely useful tool which should be required of all.
A literal reading of the question suggests the possibility of requiring BDD and
Quick Start claims from all servicemembers at discharge. We believe this to
be overly broad and, frankly, unnecessary. Discharging members must be
1 Presentation by Acting Under Secretary for Benefits to the Advisory Committee on Disability
Compensation, April 20, 2010.

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thoroughly briefed on the various programs that may be available to them as
they transition from active duty. However, not everyone leaves service with
a chronic condition potentially entitling them to benefits. Such a requirement
would be overly burdensome on VA and its associates and wasteful of scarce
government resources. We would not endorse such a proposal.
3. The Memo of Understanding (MOU) between VA and DoD largely permits
only VA physicians to conduct the single exams. Is this a problem and if so,
should more training be provided to DoD physicians so that they can conduct
these exams more often?
Response: We have insufficient information to respond substantively to this
question. We do know that VA uses some QTC contracted physicians to conduct
BDD and Quick Start exams.
4. You testified that even when comprehensive physical exams are administered, there is not enough time or resources to complete them effectively.
What might Congress do to resolve this issue?
Response: We regularly receive reports from veterans that the examinations provided them were quick and, in the veterans lay opinion, not thorough. These reports
come from both discharging servicemembers undergoing BDD/Quick Start exams
and veterans undergoing exams at VA facilities. Of particular concern are psychiatric examinations which, by their very nature, rely heavily on a review of medical records, extensive interviews and testing, all of which take time. Examinations
which experts in the field indicate should normally take 6090 minutes are completed in 1520 minutes. Unfortunately, simply reviewing examination reports does
not provide any indication of the amount of time afforded servicemembers or veterans since the report invariably appears to be complete.
We believe that a study of scheduling practices at military installations where
BDD/Quick Start examinations are given would quickly indicate what the average
examination time allotted is, together with outliers, by body system. We urge a
study of scheduling of psychiatric examinations for compensation purposes, both
original and claims for increase. Further, the study could include post examination
surveys of those examined to better understand what went on during the examination. This should provide objective data so as to better inform VA and this Committee.
5. GAO reported that VA has established only one measure for gauging the effectiveness of the BDD and Quick Start programs. However, it seems that
VA has several means for measuring general disability claims. Do you agree
additional quality measurements could assist VA in fully implementing the
BDD and Quick Start programs.

ccoleman on DSK8P6SHH1PROD with HEARING

Response: Yes.
6. Some Veteran Service Organizations express frustration by VAs lack of efforts in collaborating with them in increasing utilization of BDD and Quick
Start programs. Please expand upon the challenges faced by your organization in this regard? What can Congress do to increase the cooperation between VA and VSOs with respect to the BDD and Quick Start programs?
Response: Our testimony reflected our experiences with VA and DoD with regards to the BDD and Quick Start programs. The rank and file workers, even many
VA supervisors on military bases, recognize that VSOs can provide valuable assistance in educating and assisting discharging servicemembers. Once we are on a military base, VA staff and base officials quickly see the positive impact we have on
the claims intake portion of the BDD/Quick Start programs.
Where we have difficulty is getting on a military base in the first place. VA must
negotiate for space and access with local DoD officials, individuals who are often distracted by the realities of housing and training servicemembers who are either preparing for deployment or returning from overseas. Their focus is on the war and the
warriors who fight for our nation. It is our opinion that many within DoD do not
adequately recognize that ensuring a quality transition from military service to civilian life is just as essential as recruiting, training and leading men and women
in the defense of our nation. As a consequence, they look on VA, and by extension,
VSOs, with suspicion, thinking that our very presence will somehow distract them
and their troops from their primary mission.
As a consequence, VA often finds it difficult to obtain adequate space on a military base for its own workers. Since VA fails to include service organizations in its
BDD/Quick Start expansion plans, it is no surprise that space for service officers

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is not usually included in their planning. Once a VSO offers to place a service officer
on a base to help, it must negotiate with both base officials and the VA.
Please allow me to offer the following as an example of the problems we experience with military personnel when seeking entry to a base to help servicemembers.
Several years ago we became concerned that Army personnel going through the
DES program at Walter Reed were not adequately represented and, as a result,
were receiving decisions which significantly under evaluated the chronic problems
for which they had to leave service. We decided to place a highly qualified service
officer at Walter Reed to assist interested Army personnel. We met with a dozen
civilian and military officials at the base seeking a minimum amount of space in
which to work. We were rebuffed at every turn. Even a meeting between high level
VA officials, senior VSO executives representing the major VSOs and DoD personnel at Walter Reed failed to produce positive results. As a consequence, soldiers
at Walter Reed do not have the opportunity to consult a VFW service officer during
the DES process.
Interestingly, when we decided to shift our efforts to the Bethesda Naval Hospital,
we were able to gain access and office space with minimal effort. As a consequence,
our service officer has started helping Navy and Marine personnel with BDD and
Quick Start claims.
What we would like to see is DoD and VA actively include at least the major
VSOs in planning when BDD/Quick Start expansion is considered. VA should ask
us if we are able to provide service officers at those military bases to which they
are expanding. While we may not be able to place a service officer at every base
where VA has a presence because of budget reasons, we would certainly appreciate
the opportunity to participate.
7. Are you aware of any unique challenges encountered by members of the National Guard and Reservists in gaining information about the Quick Start
program and filing claims through this program?

ccoleman on DSK8P6SHH1PROD with HEARING

Response: We know that National Guard and Reservists returning from deployment are quickly returned to their communities and released from active duty.
Therefore they are often unable to participate in TAP briefings and do not have the
opportunity to participate in the BDD program because of the short time remaining
on active duty.
Much of VAs outreach to servicemembers is focused on over 100 military installations. With Guard units scattered across the United States and Puerto Rico, it is
a challenge for VA to find the resources to provide TAP style briefings and claims
assistance to them.
Many VSOs conduct outreach to Guard and Reserve centers. Some of these visits
are coordinated with VA. At other times we visit at the request of the Guard or Reserves. However, we are not aware of any program by VA to ensure that all returning Guard and Reserve personnel receive a timely TAP briefing along with assistance in completing claims.
There is no doubt that this is problematic for VA. Outreach is performed by VA
regional office staff, sometimes hundreds of miles distant from a Guard or Reserve
center. Further, the service to be provided is two-fold: first, brief them on what benefits and services are available to them; then assist individuals with completing
compensation claims. The first can be done in a matter of hours. Helping individuals
file claims, if done right, will take much longer.
At BDD sites, VFW service officers usually spend about an hour with each servicemember, helping them fill out the claim, pouring over service treatment records
and ensuring that all chronic conditions related to service are claimed. It is much
more difficult to provide this service to Guard and Reserve personnel because of the
number of personnel filing all at once and their distance from VA and VSO personnel.
We believe that VA could construct a plan for conducting systematic outreach and
claims assistance to Guard and Reserve personnel who have been recently deactivated. VA should work with the VSOs who work in their regional offices in order
to coordinate activities. In this way it would be possible for a number of VA and
VSO personnel to appear at a Guard or Reserve center and provide information and
services to appropriate personnel. Once such a plan is developed, it could be tested
in a number of states in order to determine the efficacy of the plan. Data could be
gathered and a report provided your Committee.
f

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Committee on Veterans Affairs
Subcommittee on Disability Assistance and Memorial Affairs
Washington, DC.
March 25, 2010
Raymond C. Kelley
National Legislative Director
AMVETS
4647 Forbes Boulevard
Lanham MD, 20706
Dear Mr. Kelley:
Thank you for testifying at the House Committee on Veterans Affairs Subcommittee on Disability Assistance and Memorial Affairs oversight hearing on the
Examination of the Benefits Delivery at Discharge and Quick Start Programs,
held on February 24, 2010. I would greatly appreciate if you would provide answers
to the enclosed follow-up hearing questions by Monday, April 26, 2010.
In an effort to reduce printing costs, the Committee on Veterans Affairs, in cooperation with the Joint Committee on Printing, is implementing some formatting
changes for material for all full committee and subcommittee hearings. Therefore,
it would be appreciated if you could provide your answers consecutively on letter
size paper, single-spaced. In addition, please restate the question in its entirety before the answer.
Due to the delay in receiving mail, please provide your responses to Ms. Megan
Williams by fax at (202) 2252034. If you have any questions, please call (202) 225
3608.
Sincerely,
John J. Hall
Chairman

ccoleman on DSK8P6SHH1PROD with HEARING

Questions from the House Committee on Veterans Affairs


Subcommittee on Disability Assistance and Memorial Affairs
Oversight Hearing on Examination of the Benefits Delivery at Discharge
and Quick Start Programs
February 24, 2010
1. How would it help VA if the Transition Assistance Program (TAP)
briefings and BDD or Quick Start exams were mandatory for all decommissioning servicemembers? Do you believe VA has the resources needed for this expansion?
It would help transitioning servicemembers if VA TAP briefings were mandatory.
AMVETS doesnt believe this will cause a resource issue, because VA is present at
most TAP briefings but servicemembers dont participate. Not all transitioning
servicemembers leave service with a disability; therefore, AMVETS does not believe
that BDD or Quick Start exams need to be mandatory. However, we would like to
see the Disability Evaluation System (DES) program expand and become mandatory
for all transitioning servicemembers.
2. What can Congress do to assist VA and DoD in expanding TAP briefings and BDD or Quick Start exams to all discharged
servicemembers?
Congress should mandate that all transitioning servicemembers must attend VA
TAP briefings.
3. The Memorandum of Understanding (MOU) between VA and DoD
largely permits only VA physicians to conduct the single exam. Is
this a problem and if so, should more training be provided to DoD
physicians so they can conduct these exams more often.
The MOU between DoD and VA is a general agreement that allows local DoD facilities to enter into MOUs with local VA facilities. These local MOUs dictate who
is responsible for what aspects of the single exams. The issues that arise are often
ones of logistics. For instance: the MOU states VA will conduct the physicals and
DoD will provide examination rooms. This seams benign enough; however, DoD may
not understand what equipment will be needed for VA to conduct a thorough exam.
A clearer explanation of what needs and expectations are for each location so there

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is not a lack of resources. In cases where DoD will be conducting the exams, it is
important that they provide a medical evaluation that is complete and in a format
that is usable by VA. AMVETS suggests that VA design medical condition templates
for DoD and civilian doctors to use to ensure all pertinent information is included
so VA will not have to conduct a second exam because critical information is not
included.
4. You testified that even when comprehensive physical exams are administrated, there is not enough time or resources to complete them
effectively. What might Congress do to resolve this issue?
Again, AMVETS attributes this to vague MOUs between local DoD and VA facilities. AMVETS believes this is a problem that can be easily solved by the two agencies. If upon their recommendations it is believed that more funding for these programs is needed then Congress should appropriate sufficient funding.
5. GAO reported that VA has established only one measure for measure
for gauging the effectiveness of the BDD and Quick Start programs.
However, it seems that VA has several means for measuring general
disability claims. Do you agree additional quality measurements
could assist VA in fully implementing the BDD and Quick Start programs?
Yes, there needs to be a more emphasis on quality. AMVETS is working with
other VSOs to construct a metric to more evenly evaluate effectiveness.
6. Some Veterans Service Organizations (VSOs) express frustration by
VAs lack of efforts in collaborating with them in increasing utilization of BDD and Quick Start programs. Please expand upon the challenges faced by your organization in this regard? What can Congress
do to increase the cooperation between VA and VSOs with respect
to the BDD and Quick Start programs?
This is more of a problem between DoD and the VSOs. For our service officers
to assist servicemembers with a Quick Start of BDD claim they need access to them
on military installations. This requires cooperation between the Commanders on
each of the bases and the VSOs.
7. Are you aware of any unique challenges encountered by members of
the National Guard and reservists in gaining information about the
Quick Start program and filing claims through this program?
Time is the largest factor in all Guard and reserve transition issues. Most demobilizations take less than one week. It is impossible to conduct a complete physical
for hundreds to thousands of returning servicemembers. The simple solution is to
provide a VA briefing prior to Guard and reserve members exit exam. This will provide them with the knowledge to tell the medical professional conduction the evaluation every condition that started or got worse while on active duty. As long as the
information is in their medical records and the veteran files for disability within one
year they will have a very quick claims process.

ccoleman on DSK8P6SHH1PROD with HEARING

f
Committee on Veterans Affairs
Subcommittee on Disability Assistance and Memorial Affairs
Washington, DC.
March 25, 2010
John L. Wilson
Assistant National Legislative Director
Disabled American Veteran
807 Maine Avenue, NW
Washington, DC 20024
Dear Mr. Wilson:
Thank you for testifying at the House Committee on Veterans Affairs Subcommittee on Disability Assistance and Memorial Affairs oversight hearing on the
Examination of the Benefits Delivery at Discharge and Quick Start Programs,
held on February 24, 2010. I would greatly appreciate if you would provide answers
to the enclosed follow-up hearing questions by Monday, April 26, 2010.
In an effort to reduce printing costs, the Committee on Veterans Affairs, in cooperation with the Joint Committee on Printing, is implementing some formatting
changes for material for all full committee and subcommittee hearings. Therefore,
it would be appreciated if you could provide your answers consecutively on letter

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size paper, single-spaced. In addition, please restate the question in its entirety before the answer.
Due to the delay in receiving mail, please provide your responses to Ms. Megan
Williams by fax at (202) 2252034. If you have any questions, please call (202) 225
3608.
Sincerely,
John J. Hall
Chairman

ccoleman on DSK8P6SHH1PROD with HEARING

Post-Hearing Questions For John Wilson, Assistant National


Legislative Director of the Disabled American Veterans
Following the February 24, 2010 Hearing of the United States House of
Representatives, House Veterans Affairs, Subcommittee on Disability
Assistance and Memorial Affairs
1. How would it help VA if the Transition Assistance Program (TAP) briefings
and BDD or Quick Start exams were mandatory for all decommissioning
servicemembers? Do you believe VA has the resources needed for this expansion?
Response: Mandatory TAP, Disability Transition Assistance Programs (DTAP)
briefings and Benefits Delivery at Discharge (BDD) and Quick Start medical examinations would ensure all separating military personnel would be better informed as
to the variety of benefits for which they qualify. Additionally, all medical evidence
necessary to determine service connection for claimed disabilities would be readily
available, which would expedite the claims adjudication process and facilitate placing any disability compensation that is due in the hands of the member shortly
after transitioning into veterans status.
Regarding the question of resources, if all decommissioning servicemembers were
required to complete TAP/DTAP and BDD/Quick Start programs, the Department
of Veterans Affairs (VA) would likely need additional resources to ensure the timely
delivery of these services.
2. What can Congress do to assist VA and Department of Defense (DoD) in expanding TAP briefings and BDD or Quick Start exams to all discharging
servicemembers?
Response: We recommend Congress provide sufficient funding, staffing and oversight for TAP/DTAP to ensure these services are available to support all routine discharges per year from each branch of service.
We further recommend Congress provide sufficient funding to ensure that members of the National Guard and Reserve forces who are activated for 12 months or
longer be afforded a period of active duty of five days, within 90 days of separation,
in order to attend TAP and DTAP workshops. Additionally, Congress should require
completion of a separation physical exam and attending TAP/DTAP as mandatory
conditions for all separating military personnel to receive the DD Form 214, Certificate of Release or Discharge from Active Duty.
3. The Memo of Understanding (MOU) between VA and DoD largely permits
only VA physicians to conduct the single exams. Is this a problem and if so,
should more training be provided to DoD physicians so they can conduct the
exams more often?
Response: The DoDs role in providing separation physical exams was modified
because of previous instances where DoD improperly applied disability standards
specified in the VA Schedule for Rating Disabilities and also because transitioning
personnel who file disability claims with the VA were subject to duplicative physical
exams in order to meet requirements of both the DoD and VA. A study in 1994 of
the Navy and Marine Corps mandated separation exams found that while they met
the services needs for a separation physical, 75 percent of the exams findings were
insufficient for the purpose of disability ratings. Often the diagnosis or findings
were not in line with the requirements of the VA rating schedule.
Maximizing the use of available physician resources whether from DoD, VA or
others provides the greatest flexibility to ensure that transitioning personnel obtain
this critical medical exam. To maximize their use, duplicative exams can be eliminated by DoD and VA establishing the use of medical examination templates, as is
currently being done in certain VA pilots, to ensure that all examinations are ade-

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quate for rating purposes regardless of source. It seems prudent to further clarify
MOU procedures accordingly.
4. You testified that even when comprehensive physical exams are administered, there is not enough time or resources to complete them effectively.
What might Congress do to resolve this issue?
Response: DAV recommends Congress provide the DoD and VA the necessary resources to ensure all transitioning military personnel applying for disability compensation receive separation physicals, whether active duty, mobilized Reserve or
Guard forces. We further recommend Congress provide sufficient funding to ensure
that members of the National Guard and Reserve forces who are activated for 12
months or longer be afforded a period of active duty of five days, within 90 days
of separation, in order to attend TAP and DTAP workshops.
5. GAO reported that VA has established only one measure for gauging the effectiveness of the BDD and Quick Start programs. However, it seems that
VA has several means for measuring general disability claims. Do you agree
additional quality measurements could assist VA in fully implementing the
BDD and Quick Start programs?
Response: The inclusion of additional quality measures could provide the VA
with information that would further enhance the effectiveness of this important program. For example, monitoring all actions taken from the date VA receives a claim,
as opposed to the current practice of monitoring all actions taken from the date of
receipt of the DD Form 214, may provide both DoD and VA with important information that resolves other process problems that are not presently apparent.
The VA/DoD Joint Executive Council has only a general focus on this area. Its
objective as found in its Strategic Plan for FY 2009 to 2011 is to improve participation in the BDD program nationwide and ensure servicemembers are afforded the
single cooperative examinations where available. The plan to streamline benefits
application processes, eliminate duplicative requirements and correct various business practices that complicate the process will prove more useful however when
there are measureable outcomes. Congressional oversight of the success of this strategic plan is also recommended.

ccoleman on DSK8P6SHH1PROD with HEARING

6. Some Veteran Service Organizations (VSOs) express frustration by VAs lack


of efforts in collaborating with them in increasing utilization of BDD and
Quick Start programs. Please expand upon the challenges faced by your organization in this regard. What can Congress do to increase the cooperation
between VA and VSOs with respect to the BDD and Quick Start programs?
Response: VSOs at a number of military installations were given access to provide free assistance to military personnel in various stages of preparation for separation from military services. In 1998, for example, VSOs at the national, state and
county level were acknowledged as playing an important role with VAROs in VBA
predischarge claims development, examinations and rating decisions (VA Circular
20982, Change 1 dated January 25, 1999). VSOs were encouraged to participate
with VAROs and to be made an integral part of the planning and execution of these
programs. VSOs were authorized to conduct TAP and DTAP briefings, consult with
personnel on VA benefits, and conduct reviews of service treatment records in order
to advise claimants and to assist them in preparing benefit applications. In Appendix A, section 10 of this same circular VSOs were identified as partners and full
integration of the veterans service organizations is important for the support of the
pre-discharge examination and claims adjudication process.
Today, VSOs access to military installations varies, with some simply not allowing VSOs access. Congressional action directing VSOs access to conduct TAP and
DTAP briefings, consult with personnel on VA benefits, and conduct reviews of service treatment records in order to advise claimants and to assist them in preparing
benefit applications is critical. If VSOs are incorporated as full partners in this area,
we could provide transitioning military personnel a critical adjunct to existing programs and could offer constructive comments to DoD and VA on delivery of services
to ensure best practices are adopted and less constructive initiatives discarded.
7. Are you aware of any unique challenges encountered by members of the National Guard and Reservists in gaining information about the Quick Start
program and filing claims through this program?
Response: A unique challenge that National Guard and Reserve personnel often
face is their rapid demobilization from active duty status which may preclude their
being fully informed about benefits potentially available to them. Additionally, since

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separation physical exams are not mandatory, this may later impact their eligibility
for disability compensation for service-connected conditions.
f
Committee on Veterans Affairs
Subcommittee on Disability Assistance and Memorial Affairs
Washington, DC.
March 25, 2010
Diana Rubens
Associate Deputy Under Secretary for Field Operations
Veterans Benefits Administration
U.S. Department of Veterans Affairs
810 Vermont Ave., NW
Washington, DC 20420
Dear Ms. Rubens:
Thank you for testifying at the House Committee on Veterans Affairs Subcommittee on Disability Assistance and Memorial Affairs oversight hearing on the
Examination of the Benefits Delivery at Discharge and Quick Start Programs,
held on February 24, 2010. I would greatly appreciate if you would provide answers
to the enclosed follow-up hearing questions by Monday, April 26, 2010.
In an effort to reduce printing costs, the Committee on Veterans Affairs, in cooperation with the Joint Committee on Printing, is implementing some formatting
changes for material for all full committee and subcommittee hearings. Therefore,
it would be appreciated if you could provide your answers consecutively on letter
size paper, single-spaced. In addition, please restate the question in its entirety before the answer.
Due to the delay in receiving mail, please provide your responses to Ms. Megan
Williams by fax at (202) 2252034. If you have any questions, please call (202) 225
3608.
Sincerely,
John J. Hall
Chairman

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Questions for the Record


House Committee on Veterans Affairs
Subcommittee on Disability Assistance and Memorial Affairs
Hearing on Examination of the U.S. Department of Veterans Affairs
Benefits Delivery at Discharge and Quick Start Programs
February 24, 2010
Question 1: What percentage of VAs current inventory of disability claims includes first-time claims from Servicemembers returning from Iraq and Afghanistan?
Response: As of March 31, 2010, the 15,932 initial claims submitted by
Servicemembers returning from Iraq and Afghanistan represent 3.2 percent of VAs
inventory of 493,732 disability compensation claims.
Question 2: Would it help VA if the Transition Assistance Program (TAP) briefings and BDD or Quick Start exams were mandatory for all decommissioning
servicemembers, and if so, how? If VA favors this expansion, does VA have the resources needed to achieve this objective? What can Congress do to assist you in expanding TAP briefings and BDD or Quick Start exams to all discharging
servicemembers?
Response: Mandatory TAP briefings would significantly help support VAs mission. TAP briefings provide VA the opportunity to promote the BDD and Quick
Start programs and provide information about Veterans benefits and services. If all
separating Servicemembers were required to attend TAP briefings, VA would need
additional resources to reach all Servicemembers, particularly those separating from
remote locations. VA is working to develop innovative ways of delivering TAP briefings for Servicemembers in situations and locations where briefings are difficult to
conduct, including those separating from naval vessels while on deployment, remote
locations, Guard and Reserve units returning from theater, and Servicemembers
serving in small detachments such as embassy guard personnel and recruiters.

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69
VA supports mandatory separation physicals for all separating, deactivating reserve component personnel and all retirees. Examinations adequate for use in the
claims process are conducted to VA standards for Veterans who participate in BDD,
Quick Start, the Joint DoD/VA Disability Evaluation System Pilot, and for those
Veterans who file a claim within a year of separation from service. This represents
approximately one half of all initial claims VA receives. The remainder of the claims
are received from Veterans many years post service. Mandatory separation
physicals need not be as extensive as an examination for a compensation claim, but
they would serve critical needs that are currently not being met. Those needs include the following: 1. The examination results, if automated, would aid in predicting future claim activity and would materially aid in VAs efforts to project future requirements in a manner similar to Social Security; and 2. The examination
results would provide a critical baseline of the state of a Servicemembers health at
time of separation that could document his/her state of hearing and vision, and determine whether isolated reports of treatment for routine medical events, such as
strains, have resolved or continue to have residuals that justify an award of service
connection.
Question 3: Despite the Memo of Understanding (MOU) between the VA and
DoD, many units are still failing to execute a single physical exam that will meet
both the VA and DoDs standards. How can we help local units to get a single examination process established? Can this problem be solved simply through education
and training, or should the policy be fundamentally changed?
Response: The existing MOUs regarding single examinations do not mandate
separation physicals for all separating Servicemembers. Rather, they are an agreement as to the standard to which examinations will be conducted (and by whom)
when they are needed for a specific purpose such as a disability claim or a retirement physical. The policy should be fundamentally changed. Mandatory separation
physicals for all Servicemembers leaving a period of active duty should be instituted
for those individuals who do not file a claim for disability benefits prior to separation. It must be recognized that this core baseline reading is a foundational piece
to any future disability decision rendered on a Veteran who chooses to file a disability claim many years after service.
Question 4: How does the effectiveness of these programs suffer through having
MOUs with DoD that largely permit only VA physicians to conduct the single
exams? If this is a problem, should more training be provided to DoD physicians
so that they can conduct these exams more often?
Response: The memorandum of agreement between VA and DoD does not specify
that the examination must be conducted by a VA physician, only that the examination be conducted in accordance with VA examination protocols. In this period of
conflict, it is not surprising that DoD, with its own clinical staffing challenges, believes that its primary focus must be on forward-deployed health and health maintenance of the force. Locally, individual VA regional offices, VA medical centers and
military treatment facilities (MTFs) will sign a memorandum of understanding, defining each agencys responsibilities. Responsibility for completing the exam (or aspects of the exam) is based largely on the availability of each agencys resources at
or near the location.
If DoD physicians are available at MTFs, training in many cases is provided
through VHAs examiner testing protocol to enable DoD clinicians to conduct examinations in accordance with VAs examination protocols.
Question 5: The Government Accountability Office (GAO) testified that VA has
established only one measure for gauging the effectiveness of the BDD and Quick
Start programs. However, it seems that VA has several means for measuring general disability claims including: (a) how much time a veteran has to wait for a final
decision, (b) average days to complete all work to reach a final decision, and (c) percentage of claims with no processing errors. I understand that if VA performed
these surveys, such as tracking total time to develop a claim, the results may suggest that VA has more work to do to achieve its goals. However, cant these additional performance measurements assist VA in fully implementing the BDD and
Quick Start programs?
Response: The effectiveness of the BDD and Quick Start programs is generally
gauged utilizing the same measurements applied to all other disability claims.
These measurements include average days to complete (average days to complete
all work) and average days pending (average age of the currently pending workload). VA conducts the same quality assurance reviews for the sites that process
BDD and Quick Start claims as are used for other regional offices.

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BDD claims present unique issues with regard to measuring average days to
process and average days pending in that there are significant differences when
compared to normal Veterans claims processing. If VA were to measure from the
date the Servicemember filed his/her claim, both of these measures would be meaningless since they would be controlled by: (a) when the Servicemember filed his/her
claim in relation to his/her expected separation date; and (b) the fact that VA cannot
influence this time since VA has no legal authority to finalize the decision and make
payment until the member separates. Thus, we believe that the true measure of the
success and effectiveness of the pre-discharge programs is the time delay between
separation and notification of entitlement.
Question 6: Veterans Service Organizations (VSOs) suggest they can play a critical role in improving the implementation of BBD and Quick Start programs. What
can we do to increase your cooperation with VSOs in this regard? What challenges
might you face in forging this cooperation?
Response: At the Transition Assistance Program briefings, VA advises
Servicemembers about the opportunity to be represented by a VSO. There is no inherent legal or VA-imposed process limitation in the ability of service organizations
to represent Servicemembers in the VA claims process while they are still on active
duty. In fact, partnerships exist with various organizations, including state Departments of Veterans Affairs, at some BDD sites. We are aware, however, that service
organizations sometimes have difficulty obtaining office space on military installations due to the widespread space scarcity on most installations following consolidation of facilities through the BRAC activities.
Question 7: What unique challenges does VA encounter with educating members
of the National Guard and Reservists about the BDD and Quick Start programs,
and processing the Quick Start claims? How many Quick Start claims do you process each year? How many do you complete annually?
Response: Normally, deployed members of the reserve components cannot participate in the BDD program because of the extremely brief period of time that they
have on active duty following return from theater. VA often receives limited notice
of the demobilization events and has limited time to interact with the
Servicemembers.
When VA reaches Servicemembers at the demobilization events, there is insufficient time to conduct medical examinations and gather evidence while on active
duty. VA accepts Quick Start claims at demobilization events, but locating and obtaining service treatment records from individual units can be time consuming. Frequently there is a delay, sometimes significant, in associating in-theater treatment
records with their medical jacket. VA completed 16,162 Quick Start claims during
FY08, and 22,021 Quick Start claims during FY09. This fiscal year 11,712 Quick
Start claims have been completed through the end of March. We do not have a report that identifies which of those claims was from reserve component
Servicemembers.
Question 8: What can this Committee do to assist VA in addressing any technical
or training issues related to the BDD and Quick Start programs? Will the 4,000 additional disability raters requested in the Administrations FY11 budget make any
impact in the ability to expand the BDD and Quick Start programs?
Response: VA requests the House Committee on Veterans Affairs maintain its
current level of support to ensure the continuing success of the BDD and Quick
Start programs. The additional staffing in VAs 2011 budget submission are primarily focused on addressing the increasing demand for services as represented by
the unprecedented claim rate, including claims received through the BDD and Quick
Start programs. VA continues to seek opportunities to reach out and assist separating Servicemembers while they are on active duty and is committed to supporting
the smooth transition from military to civilian life.

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